What are Accountable Care Organizations?

What is Accountable Care Organizations What is Accountable Care Organizations

Accountable Care Organizations – Overview

An accountable Care Organization (ACO) is formed when medical professionals, hospitals, and other healthcare providers collaborate voluntarily. An ACO is formed to care for a designated group of patients. Some private insurance providers have agreements with ACOs that ensure that patients suffering from a particular type of medical disorder or disease can receive affordable and top-quality medical care.

This method of coordinated care means that patients, especially the chronically ill, receive the right care at the right time. An ACO helps patients avoid unnecessary duplication of services and prevents medical errors.

Medicare ACOs provide top-notch healthcare services at affordable cost, which helps to share the savings for the Medicare program. According to studies by the American Hospital Association (AHA), the majority of hospitals and health systems in the US have adopted alternative payment and delivery models, such as ACOs.

The studies show that around 82% of the patient population benefits from traditional Medicare ACOs, while 67% of patients receive ACO benefits under commercial insurance. Additionally, nearly 53% of patients receive ACO benefits under Medicare Advantage, while the figure for Medicaid beneficiaries with ACOs is around 30%.

How Do Accountable Care Organizations (ACOs) Work?

An ACO provider receives certain benefits for collaborating on a patient’s treatment, irrespective of the type of care, whether in hospitals, clinics, or long-term care facilities. An ACO aims to ensure that every patient receives the best care, especially if they suffer from chronic conditions like diabetes or heart disorders.

ACOs are there to ensure that every healthcare provider works in collaboration with other providers on your care team.

ACOs are incredibly beneficial for healthcare providers and patients alike. For instance, an ACO ensures better communication between your primary healthcare provider and specialists, streamlines healthcare between doctors, hospitals, and long-term care providers, and ensures smoother operations of healthcare providers and local care services, such as Meals on Wheels.

As ACOs ensure that patients receive optimal care, it brings down the overall cost of treatment, which helps Medicare to save a significant amount of money. The healthcare providers involved in ACOs receive a share of these additional savings.

What Are the Benefits of ACOs for Patients?

Accountable Care Organizations

Accountable Care Organizations – What Are the Benefits

Here are the top benefits of ACOs for patients:

1. Improved Healthcare at a Lower Cost

The incredible level of collaboration between healthcare providers in an ACO makes it easier to share your medical history and streamline treatment. In turn, ACO doctors are able to provide efficient and cost-effective healthcare services.

The ACO team aims to provide the patient with the best quality care and discharge as quickly as possible. This also lowers out-of-pocket expenses for patients.

2. Better Coordination for the Best Care

Chronically ill patients usually need to be evaluated by different specialists. Normally, the two specialists are unaware of the other’s recommendations and treatment plans. This might result in you, the patient, having to undergo the same tests twice, which will likely drive up the overall cost of your treatment. However, with ACOs, this is less likely to happen.

Additionally, ACOs prepare a specific treatment plan for chronic diseases and disorders. This service is usually handled by a “care coordination,” which is usually a social worker or nurse, to ensure that every patient receives the correct care at the right time.

3. Enhances Accountability of Healthcare Providers

ACOs are also meant to keep doctors accountable for their care quality. The medical professionals who are part of an ACO are paid higher if they prove the improvement in the patient’s health. For instance, an ACO needs to prove that a team of healthcare providers is involved in a patient’s care, besides proving that the patient is receiving preventive services, such as flu shots, etc. The ACO is mainly judged on 33 different parameters by the insurance provider.

How to Become an ACO Patient?

You don’t need to enroll in an ACO, as it is not health insurance. This is your doctor’s decision to create a team for patient care in adherence to the insurance provider’s guidelines and regulations.

If your healthcare provider is part of an ACO and provides you care under it, then you will be assigned to your provider’s ACO. The ACO will also explain the type and extent of care that you, the patient, will receive from them.

Patients don’t need to become part of an ACO, as it is the doctor’s prerogative. However, if your doctor is part of an ACO, you will benefit from the streamlined and coordinated care offered by the group. Each member of an ACO team dedicated to your care has easy access to your medical history, conditions, and prescriptions, which makes it possible to offer the best-suited and most effective treatment.

Top Accountable Care Organizations (ACO) in 2023

Here is a list of the top-ranking ACOs in the US in 2023:

1 – Palm Beach Accountable Care Organization

The Palm Beach ACO (PBACO) works under Medicare Shared Savings Program (MSSP) and is the top earner, with an astonishing USD 61.9 million in earned savings in 2021. This physician-owned and operated organization have an extensive membership, with 275 primary care providers and 175 medical specialists. The PBACO cares for more than 79,000 Medicare patients in New York State and Florida.

In addition, PBACO earned a 100 percent quality score for the second year in a row, maintaining its top position from the previous year.

2 – Baylor Scott & White Quality Alliance

The Baylor Scott & White Quality Alliance improved its performance between 2020 and 2021 by earning around USD 14 million during the period. The Texas-based ACO also earned around USD 61 million to be distributed across its 50 member hospitals and more than 95 acute care facilities in the United States.

This ACO scored 98.48 percent quality in caring for over 125,000 Medicare patients, the 5th highest number of all ACOs.

3 – Privia Quality Network (Virginia, Maryland, Washington D.C.)

The Privia Quality Network of Virginia, Maryland, and DC earned around USD 41.6 million in performance payments in 2021. This ACO also expanded its service network by including members of Florida, Tennessee, and Maryland.

4 – Caravan Health Collaborative ACO

The Caravan Health Collaborative ACO, or Caravan Health for short, is a recent ranker on the top ACO list and earned around USD 35.35 million in performance payments. Signify Health bought Caravan for USD 250 million at the beginning of 2022 and has successfully expanded it into a renowned ACO, which focuses on risk sharing and low fees.

Medicare data shows that Caravan Health served more than 220,000 patients in 2021, which is the highest number of beneficiaries of all ACOs in the US.

5 – Steward National Care Network

The Steward National Care Network is a subsidiary of Steward Health Care and earned around USD 34.49 million in performance payments from Medicare in 2021. This resulted in the company scoring 88.79 percent in quality score and also established it as one of the more extensive ACO networks with over 161,000 Medicare beneficiary’s services in 2021.

Conclusion

An ACO is a collaboration between different types of healthcare providers, including clinicians, specialists, and healthcare service providers, such as hospitals and long-term care facilities. Patients receive optimal quality health care and prompt relief through ACOs, which are, in turn, rewarded by Medicare or other types of health insurance providers that the ACO members are part of.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422096/

https://innovation.cms.gov/innovation-models/aco

https://www.cms.gov/medicare/medicare-fee-for-service-payment/aco#:~:text=What%20is%20an%20ACO%3F,care%20to%20their%20Medicare%20patients

See Also

What is a Contingent Beneficiary?

What is Roe vs Wade?

What is a National Provider Identifier?

What is a Medical Credit Card?

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