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Monday, July 9, 2012

ACO - Accountable Care Organization - What is it all about

This morning I received my usual set of Healthcare related news. One of the articles published by ModernHealthcare caught my attention.

"CMS announces 89 new ACOs" - as I read about this news, I realized that many of those whose lives are affected by the changes in healthcare delivery do not know what ACO is and how does it change the delivery of healthcare for Medicare Recipients.

From the article I gather that CMS (Center for Medicaid and Medicare services) engaged more ACOs through out the country. See the body of the article below:

As of July 1, 89 new Medicare accountable care organizations (PDF) started to serve Medicare beneficiaries in 40 states and Washington, D.C., the CMS announced Monday.

These new programs bring the total list of ACOs to 154, which includes 32 ACOs in the Pioneer ACO model from the CMS Innovation Center that were announced last December and six physician group practice transition demonstration organizations that began in January 2011. 

“The Medicare ACO program opened for business in January, and already, more than 2.4 million beneficiaries are receiving care from providers participating in these important initiatives,” CMS Acting Administrator Marilyn Tavenner said in a statement.
On the official CMS website I found a detailed description of what the ACO is all about and what available programs for are available to get involved if you are a provider, or a Healthcare professional. Please see the explanation below:

Accountable Care Organizations (ACO)

What's an ACO?
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.
The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it willshare in the savings it achieves for the Medicare program.
Medicare offers several ACO programs:
  • Medicare Shared Savings Program—a program that helps a Medicare fee-for-service program providers become an ACO. Apply Now.
  • Advance Payment Initiative—a supplementary incentive program for selected participants in the Shared Savings Program.
  • Pioneer ACO Model—a program designed for early adopters of coordinated care. No longer accepting applications.Organizations across the country have already transformed the way they deliver care, in ways similar to the ACOs that Medicare supports.
Organizations across the country have already transformed the way they deliver care, in ways similar to the ACOs that Medicare supports.
As a healthcare provider, must I participate in an ACO?
Participating in an ACO is purely voluntary for providers. We realize different organizations are at different stages in their ability to move toward an ACO model. We want to try to meet you where you are. Our hope is to show you models of participation that will encourage you to participate in and begin this work, no matter your organization’s stage.
What are the rights of my Medicare patients if they see providers who participate in a Medicare ACO?
Fee-for-service Medicare patients who see providers that are participating in a Medicare ACO maintain all their Medicare rights, including the right to choose any doctors and providers that accept Medicare. Whether a provider chooses to participate in an ACO or not, their patients with Medicare may continue to see them.
Where can I learn more about ACOs?
CMS offers different learning opportunities for organizations interested in learning more about ACOs. Visit this page periodically to learn about the latest opportunities.
Included in those opportunities are ACO Accelerated Development Learning Sessions (ADLS). CMS hosted two ADLS this year (June in Minneapolis; September in San Francisco), and will host an additional session in Baltimore on November 17-18. The ADLS help executive leadership teams from existing or emerging ACO entities:
  • Understand their current readiness to become an ACO.
  • Identify organization-specific goals for achieving the three-part aim of improving care delivery, improving health, and reducing growth in costs through improvement.
  • Begin to develop an action plan for establishing essential ACO functions.
For more information about the ADLS and to view resources from previous sessions, visit the ADLS website.
How else is Medicare encouraging coordinated care?
The CMS Innovation Center offers a menu of alternative options, including:
We want to try to meet you where you are. Our hope is to show you models of participation that will encourage you to join in and begin this work, no matter your organization's stage.

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