Is an Accountable Care Organization Right for You?

An accountable care organization (ACO) is a group of doctors, hospitals, and other health care providers that work together on your care. Their goal is to give you -- and other people on Medicare -- better, more coordinated treatment.

When different experts are working together to help you, you're more likely to get the care you need, when you need it. Together, they can keep you from having costly tests or treatments you don't need. And their teamwork could prevent mistakes. ACOs may be most helpful if you have a chronic illness, like diabetes, high cholesterol, or high blood pressure.

Here are answers to questions you might have about ACOs.

How do accountable care organizations work?

ACO providers are rewarded for working together on your treatment no matter where you get your care -- including doctor’s offices, hospitals, and long-term care facilities. The goal of an ACO is to make sure you get better care, especially if you have conditions such as heart disease or diabetes.

ACOs make sure that everyone who cares for your health is in touch with everyone else on your team. Communication improves between your:

  • Primary care doctor and your specialists
  • Doctors, hospital, and long-term care providers
  • Health care providers and local services, like Meals on Wheels

Doctors and other health care providers will benefit from ACOs, too. If your care improves and the cost of it goes down, Medicare saves money. The health care providers in your ACO get a share of those savings.

How would I benefit from an ACO?

Better care, lower costs. By sharing information about your medical history and coordinating your treatment, your ACO doctors can provide better care. The team will work to keep you healthy and out of the hospital. That means lower out-of-pocket costs for you.

Coordinated care. Let's say you see two different specialists, one for diabetes and another for a heart condition. One doctor may not know what the other is recommending. You might end up having the same tests more than once. But if you're in an ACO, this is much less likely to happen.

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Also, ACOs must have a specific plan in place to improve your health, particularly if you have more than one chronic condition. You may have a “care coordinator” such as a social worker or nurse to help make sure you get the care you need.

Accountability by your medical providers. ACOs keep your doctors accountable. They get paid more if they can show Medicare that your health is improving. For instance, an ACO must show that a team is working on your care. They must show that you are getting preventive services, like a flu shot or a colonoscopy. Your ACO will be judged on33 quality measures.

How do I become an ACO patient?

You don't enroll in an ACO. It's not health insurance. It's something your doctor decides to create for his or her patients, following guidelines from Medicare.

Here's how it works. If a doctor provides most of your care and belongs to an ACO, you will be assigned to that doctor's ACO. If your doctor is part of an ACO, the ACO should tell you so and explain what it means for your care.

You do not have to change doctors. As a Medicare patient, you have the right to see any doctor or health provider who takes Medicare. That means you can see a doctor in an ACO and doctors who are not in ACOs.

You do not have to be part of an ACO. Part of the advantage of an ACO is that your doctors will share information to improve your care. That includes your medical history, conditions, and prescriptions. But if you don’t like the idea, you have the right to say no. You can opt out of sharing your personal health information with the ACO.

WebMD Medical Reference Reviewed by Sarah Goodell on November 08, 2018

Sources

SOURCES:

Center for Medicare & Medicaid Innovation: "Accountable Care Organizations (ACOs): General Information."

Centers for Medicare & Medicaid Services: "Accountable Care Organizations," "Medicare Shared Savings Program: A New Proposal to Foster Better, Patient-Centered Care," "Summary of the Final Rule Provisions for Accountable Care Organizations under the Medicare Shared Savings Program."

Families USA: "A Closer Look at ACOs."

Federal Register, Nov. 2, 2011: "Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations; Final Rule."

Medicare.gov: "Accountable Care Organizations."

U.S. Department of Health and Human Services: "Accountable Care Organizations: Improving Care Coordination for People with Medicare."

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