An ACO (Accountable Care Organization) refers to a group of healthcare providers and suppliers of services that will work together to coordinate care for the patients that they serve.
The ACO is a patient-centered organization where the patients, providers, & suppliers are true partners in optimal care decisions. The goal of coordinated care is to ensure that patients get the right care at the right time, delivered the right way, all while avoiding unnecessary duplication of services and preventing medical errors. We are successful in improving the “Three Objectives”: 1. Better Healthcare Outcomes 2. Better Patient Experiences 3. Lower Overall Healthcare Costs
Being an ACO “participant” means you are a provider or supplier willing to work together towards the “Three Objectives” because it’s the right thing to do for our patients, and when successful share in the additional financial benefits of doing so.
You will be assigned a population of patients by one of two methods, determined by the specific payor: 1) “Plurality of Claims”- which patients you saw more than any other provider OR 2) “Patient PCP Designation” – selected at enrollment or renewal by the patient.
Together, we will perform a 3 year “look-back” of what your attributed patients total spend across the continuum of care (PCP, Specialists, Pharmacy, Hospital, Home Health, SNF, Etc.) to assign an average cost & quality Benchmark for improvement goals.
3. SHARED SAVINGS:
We apply a proven strategy, and work together to reduce unnecessary ER visits, unnecessary specialist visits, avoidable hospitalizations, avoidable readmissions, & unnecessary/duplicated spend throughout the continuum of care. By doing so there is significant opportunity for reduction of overall costs. As overall healthcare costs fall below “spend trend” (average total cost plus inflation), we have a Shared Savings arrangement with payors. We then share the “Shared Savings Payments” creating significant, diversified, and much needed new revenue streams back to our PCP partners!
IT DOESN’T! Participating with an ACO does not change your Fee For Service funding by payors! By being a participant it simply states, IF/WHEN we are successful in reducing unnecessary costs, we will share in additional revenues created by “Shared Savings Payments”
As it stands today, our alignment has selected not to accept any financial risk. What that means is, for a lesser reward (50% vs. 60%), our organization, PCP partners, etc. takes NO RISK whatsoever, and only benefits when successful.
IF at any point in the future, we, as a group, decided to accept the risk for the greater reward, you will be notified and at that time and you will be given the opportunity to make a decision to participate; furthermore, you are NOT obligated in any way to participate in a risk model. We, both our organization and PCP partners, really value this “NO RISK, OPPORTUNITY ONLY” to do what is best for our patients with the additional data that is provided to us/you when you agree to participate.
There is no cost to you to join, but you have a great opportunity to gain! Our goal is to replicate proven results & more than double the take home of ever PCP and “practice champion” working with us.
When PCPs have access to their patients’ comprehensive data throughout the healthcare continuum, the result is reduced gaps in care, reduced medical errors, and numerous identification metrics of ideal care such as: best specialists, centers of excellence, optimal therapeutics, etc.
Additionally, providers have access to health coaches, care managers, etc., supporting their PCP directives in ways they have never had before. Patients receive higher quality of care, patients have better experiences throughout the healthcare system, and patients benefit from lower overall costs.