FAQs
What is an ACO?
Accountable Care Organizations (ACOs) are networks of healthcare providers that come together to achieve the Triple Aim, which includes three overarching goals:
- Improve Population Health, measured by the value of care provided to patients with “value” defined as health outcomes achieved per dollar spent
- Improve Patient Care, measured by patient satisfaction results
- Lower Costs, through increased coordination which reduces duplication of services and helps identify gaps in preventative care
What is Coordinated Care?
Coordinated care refers to the efforts of healthcare providers to deliver patient-centered and cost-effective care to all patients. Coordinated care includes:
- Increased communication between primary care providers, specialist providers and patients to create the best plan of care possible
- Informed healthcare providers who can anticipate patient needs before serious complications occur
- Waste reduction by decreasing duplication of services and unnecessary testing
- Development of new programs and services to better fit the unique needs of patients and communities
- Commitment to improving the delivery of healthcare services and patient outcomes
How will ACOs and Population Health benefit patients?
ACOs under a Population Health department provide value for all patients regardless of individual healthcare needs. Patients with chronic illnesses, such as diabetes, high blood pressure and high cholesterol will find value in the ACO population health model through better health management and personalized treatment plans. Healthy patients will notice an increased emphasis on maintaining a healthy lifestyle and recommendations for appropriate screenings and regular preventative care. As a result, patients can expect to reduce their risk for serious health complications and optimize their well-being.
How can patients take advantage of ACO benefits?
ACOs will be most successful when patients consistently receive care from the same physician within the same clinical setting. In the ACO model, patients choose the doctors they see but are encouraged to select a primary care provider (PCP) to visit regularly for all healthcare needs.
Coordinating care through one PCP or a centralized location (sometimes referred to as a ‘medical home’) allows patient data to be stored in one place where all physicians providing care can access vital information quickly. This helps to ensure that patients receive the right treatment at the right time even if their regular PCP is not available.
How will an ACO get me healthy or keep me healthy?
A key component of MercyOne’s Population Health ACO models include the Health Coach Program. MercyOne Health Coaches are licensed, registered nurses stationed within primary care clinics. Health Coaches work in conjunction with primary care providers to provide personalized, one-on-one care to help patients set and achieve their health improvement goals.
Health Coaches follow-up with patients who may be at higher risk for developing chronic illnesses and also work with healthy patients to provide reminders for regular healthcare screenings.
How is an ACO different from an HMO?
The ACO model is different from other managed care plans you may be familiar with. Health Maintenance Organizations (HMOs), popular in the 1990s, were designed to strictly manage services and costs. HMOs required patient participants to have a primary care provider (PCP) and required these patients to have a PCP referral before seeing a specialist. The ACO model does not require referrals for specialists. The goal of an HMO was to limit services, while the ACO model considers your whole health to ensure you receive the right care at the right time for the right reasons.
I received an MSSP Patient Beneficiary Notification Letter. Why did I receive this notice? What does this notice mean to me?
You may have received a letter to let you know that MercyOne participates in an Accountable Care Organization (ACO). Each year, we are required to notify you of our participation.
There is no action required from you. Your Medicare benefits are not changing. Your choice of provider also does not change - you have the right to visit any doctor, hospital or other provider that accepts Medicare at any time, just like you do now.
To coordinate your care better, we receive data from CMS on health care you received outside of our organization. If you would like to decline data sharing, you may call CMS at 1-800-MEDICARE and let the operator know your health care provider is participating in an ACO, and you don’t want to share your health care information with the ACO.
Additional information on why this notification is a requirement can be found on the CMS website here.
