Accountable Care Organization: The New Picture of Health Care

Accountable Care Organization: The New Picture of Health Care

Scheduled to launch in January 2012, Accountable Care Organizations (ACO) are going to be the new face of Medicare.

ACOs are a new model for delivering health services that offers doctors and hospitals financial incentives to provide quality care to Medicare beneficiaries while keeping down costs.

ACOs are organizations that form a network of health care providers working together to ensure quality care, fiscal responsibility and overall health for a specific population. In a typical ACO, hospitals align themselves with physician groups and work together to reduce costs.

Under this new law, ACOs agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.

The ACO will:

• Have the flexibility to select a model best suited for their organization,

• Improve performance resulting in financial rewards,

• Be proactive and data rich; and

• Reduce re-hospitalizations with prevention and anticipation.

ACOs must also partner with sufficient providers to meet patient needs and establish a legal structure to share the saving bonuses among the providers.

Additional guidelines for ACOs include:

• Ensuring that a governance structure and management process is in place to include administrative and clinical systems,

• Having a defined process to promote evidenced-based practices; and

• Report data for quality evaluation and cost measures, infrastructure development and demonstrate integrated care.

For more information on ACOs, please visit www.cms.gov.