Accountable Care Organizations

Accountable Care Organizations (ACOs)

Accountable Care Organizations (ACOs) are groups of physicians, other health care providers, and facility providers (e.g. hospitals) who come together voluntarily to provide coordinated high-quality care to the patients they serve who are on Medicare. This coordinated care helps ensure that patients, especially those who are chronically ill, get the right care at the right time, while avoiding duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars efficiently, it receives of a portion of the savings it achieves for the Medicare program. Unlike traditional Medicare fee-for-service, revenue is not related to volume of services, but rather the quality and cost of services.

ACO Programs at the Centers for Medicare and Medicaid Services

Medicare offers several ACO programs, including:

• Medicare Shared Savings Program (cms.gov) - For fee-for-service beneficiaries
• ACO Investment Model - For Medicare Shared Savings Program ACOs to test pre-paid savings in rural and underserved areas
• Advance Payment ACO Model - For certain eligible providers already in or interested in the Medicare Shared Savings Program
• Next Generation ACO Model - For ACOs experienced in managing care for populations of patients
• Pioneer ACO Model - Health care organizations and providers already experienced in coordinating care for patients across care settings
• ACO Reach - The ACO Realizing Equity, Access, and Community Health (ACO REACH) Model provides novel tools and resources for health care providers to work together in an accountable care organization (ACO) to improve the quality of care for people with Traditional Medicare. REACH ACOs are comprised of different types of providers, including primary and specialty care physicians. To help advance health equity, the ACO REACH Model requires all participating ACOs to have a robust plan describing how they will meet the needs of people with Traditional Medicare in underserved communities and make measurable changes to address health disparities. Additionally, the model uses an innovative payment approach to better support care delivery and coordination for people in underserved communities.

Find out what ACOs are operating in your area: https://www.cms.gov/priorities/innovation/where-innovation-happening