Accountable Care Organizations

What is an ACO?

The Centers for Medicare and Medicaid Services (CMS) define accountable care organizations (ACOs) as groups of health care providers that agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries assigned to it. ACOs, in other words, are networks of doctors that share responsibility for providing coordinated care to patients across a variety of settings.

The Patient Protection and Affordable Care Act of 2010 (PPACA) created accountable care organizations by requiring CMS to establish a savings program that would reward physicians for improve the quality of care for Medicare fee-for-service beneficiaries.

ACOs can have the following member composition:

  • Physicians, nurse practitioners, clinical nurse specialists, and hospitals in group practice arrangement
    Networks of individual practices of ACO professionals
  • Joint venture between hospitals, providers, and commercial payer organizations
  • Hospitals employing ACO providers
  • Rural health centers, critical access hospitals, federally qualified health centers, and home health networks
  • Other Medicare providers and suppliers as determined by the Secretary of the U.S. Department of Health and Human Services (HHS)

Why Choose IMS for Your Accountable Care Needs?

Accountable care organizations focus on providing patients with medical care that is both effective and affordable. This is accomplished by facilities collaborating with each other and sharing health information across a common EMR platform, thereby preventing unnecessary duplication of tests and services.

IMS’ electronic medical record software is perfect for ACOs. With total customizability, an intuitive dashboard, sensible features, and system interoperability, IMS offers the perfect EMR solution for the unique needs of accountable care organizations. Our EMR software provides physicians with access to the tools they need in order to provide the best comprehensive health care possible. Our features include:

  • Complete care management system
  • Full integration for different providers
  • Ability to manage at-risk populations
  • Clinical analytics and reporting functions
  • Data sharing and integration
  • Ability to automate patient outreach and engagement
  • Sharing of financial and billing data
  • One thing that accountable care organizations need in order to make this happen is to successfully implement an EMR system that does not disrupt workflow and other patient care-related processes. This is possible with IMS EMR designed specifically for Accountable Care Organizations.

ACO Eligibility

In order to participate in the ACO program, eligible healthcare providers must meet the following requirements:

  • Agree to be accountable for the quality, cost, and overall care of Medicare fee-for-service beneficiaries Agree to participate in the program for at least three years
  • Have a formal legal structure that allows the ACO to receive and distribute Medicare payments to participating providers
  • Include at least 5,000 beneficiaries
  • Have enough primary care physicians to for the number of beneficiaries
  • Institute a leadership and management structure
  • Define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care
  • Demonstrate that the ACO meets patient-centered criteria
  • Establish a process for evaluating the health needs of its population
  • Agree not to participate in other Medicare shared savings programs.

Quality Measures

Accountable care organizations must also demonstrate having met quality performance standards for each year that they participate in the ACO program. CMS uses 33 measurements within five key domains to measure better care for individuals and better care for populations. These include:

  1. 1. Patient/Caregiver Experience
  2. 2. Care Coordination
  3. 3. Patient Safety
  4. 4. Preventive Health
  5. 5. At-Risk Population/Frail Elderly Health

Why Join An ACO?

Instead of rewarding physicians for seeing a high volume of patients ACOs are rewarded for keeping costs down and creating a better overall patient experience.. However, the main focus of these organizations is improving quality of care for patients. When ACO participants accomplish this, they qualify for bonus payments through CMS. Over time, physicians who choose not to participate in ACOs will likely see continued reductions in fee-for-service reimbursements.

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