Accountable Care Organizations
Accountable Care Organizations (ACOs) are collaborative groups of healthcare providers, including doctors, hospitals, Medical Case Managers, social workers and other medical care professionals that work together to deliver coordinated, high-quality care to Medicare patients. Providers partner with the ACO, and the ACO partners with the Karring Group. This approach aims to improve patient outcomes, particularly for those with chronic conditions, by ensuring they receive appropriate care without unnecessary duplication or errors. ACOs that successfully deliver quality care while managing costs may receive a share of the savings achieved for the Medicare program.
Medicare-Medicaid ACO Model
How It Can Help You
How this MODEL works:
- It’s a joint initiative between the Centers for Medicare & Medicaid Services (CMS) and participating states to integrate care for individuals who are eligible for both Medicaid and Medicare (dual eligibles). The program aims to improve coordination of care, enhance quality, and reduce costs for these beneficiaries by aligning incentives for providers through accountable care organizations (ACOs). These ACOs are responsible for coordinating care across the two programs to ensure that dual eligibles receive the right care at the right time.
Department of Health & Human Services:
- This is in accordance with the Department of Health and Human Services’ “Better, Smarter, Healthier” approach to improving our nation’s health care and the Administration setting clear, measurable goals and a timeline to move the Medicare program — and the health care system at large — toward paying providers based on the quality rather than the quantity of care they provide to patients. CMS is adding the Medicare-Medicaid ACO Model to its existing portfolio of ACO initiatives.
Medicare ACO Background:
- Medicare ACOs consist of groups of healthcare providers who voluntarily collaborate to offer coordinated, high-quality care to Medicare fee-for-service beneficiaries. These organizations prioritize patient-provider partnerships, allowing patients to maintain all their Original Medicare benefits and see any Medicare provider. Successful ACOs can share in the savings they achieve for the Medicare program, promoting efficient use of healthcare resources. ACOs aim to streamline care coordination, particularly for those with chronic conditions, to ensure appropriate care, reduce errors, and avoid duplicative services. By alleviating the burden of fragmented care, ACOs empower patients and strengthen provider-patient relationships, ultimately enhancing the overall quality of care.
Eligibility:
- The Request for Letters of Intent outlines initial ACO eligibility criteria, but states and CMS may add more criteria during the state-specific development. A state-specific Request for Applications will follow for ACOs. ACOs must also apply for or renew their Participation Agreement for the Shared Savings Program to join the Medicare-Medicaid ACO Model. Providers are encouraged to engage in the state-specific process and submit letters of interest along with their state’s Letter of Intent.
Summary
The Medicare-Medicaid ACO Model ensures patient access to high-quality care and is evaluated based on its effectiveness in delivering improved care, health outcomes, and cost containment. CMS will publicly report the performance of these ACOs on quality measures, including patient experience ratings. States can collaborate with CMS to tailor certain aspects of the Model, such as Medicaid financial methodology, quality measures, and eligibility requirements, to meet their specific needs and include additional beneficiary populations, subject to CMS approval.