What’s an ACO?

An accountable care organization is comprised of a group of healthcare providers who work collaboratively to deliver coordinated care and chronic disease management, improving the quality of care patients receive.

A participating organization’s payment is tied to achieving healthcare quality goals and outcomes that result in cost savings. Medicare ACOs were formed by the Patient Protection and Affordable Care Act of 2010 (PPACA), with Medicaid and commercial accountable care organizations following suit.

Eligible ACO Membership

An accountable care organization (ACO) can be composed of the following member structures:

• Primary care physicians, specialists, nurse practitioners and clinical nurse specialists in a group practice arrangement

• Networks of individual practices of accountable care organization professionals

• Joint ventures between hospitals, providers and commercial payer organizations

• Hospitals employing accountable care organization providers

• Federally qualified health centers (FQHC), rural health clinic (RHC) facilities, eligible critical-access hospitals, and home health networks

• Other Medicare providers and suppliers as determined by the Secretary of the U.S. Dept. of Health and Human Services (HHS)

The Shared Savings Final Rule offers flexible start dates for Medicare Accountable Care Organization entities. To participate as a Medicare ACO, an entity must maintain the 5,000-patient minimum required under the final rule. Providers may join more than one entity. Membership is available to a wide range of care providers in an effort to coordinate care among various settings. Medicaid ACOs follow a similar structure.

Commercial or private accountable care organization arrangements aren’t subject to PPACA regulations and continue to form around the country. Models involve payers, hospitals and physician groups. Health insurers are also implementing payment systems that reward quality care outcomes.

A foundation for improved population health

As a proposed pillar of community health merging ambulatory primary care with multi-specialty, hospital, rehabilitation and other healthcare entities and needs, accountable care organizations (ACOs) will be linked through innovative electronic health record (EHR) and related health IT platforms to achieve seamless and comprehensive medicine.

Major Accountable Care goals

• Harness growing healthcare costs annually approaching $3 trillion

• Advance EHR-driven preventive medicine, care coordination and wellness focusing on each patient’s care continuum under a patient-centered medical home (PCMH) concept

• The ability to collect and analyze clinical, claims and payer data to enable quality monitoring and reporting

• Promote remote monitoring/telehealth to advance the communication of care plans to patients

ACO quality measures

The Centers for Medicare & Medicaid Services (CMS) currently has 31 quality measures for members of a Medicare ACO to report against to determine whether the entity qualifies to share in the savings.

Commercial ACOs enter into similar risk-sharing payment models; however, quality measures may vary significantly between various private payers. Organizations that meet agreed-upon performance levels on a range of specific quality measures are rewarded financially and are penalized for exceeding spending targets.

The ACO solution

Through our integrated technology and revenue cycle solution solution, ACOs can experience the robust integration, usability and point-of-care workflows necessary to deliver evidence-based, long-term, coordinated care.  Get in touch to learn more about how our powerful solutions can give you the insights you need for both your organization and your patients, right when you need them.