accountable care organization (ACO)
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Introduction
A formally organized entity of physicians & other health care professionals responsible through contracts with payers for providing a broad set of health care services to a specific population.
Organizations must demonstrate a sufficient number of providers within the network to manage the number of patients covered[2]
Goals of an ACO include:
- control of health care costs
- focus on prevention
- improve quality of healthcare for chronic conditions
Centers for Medicare & Medicaid (CMS) offer providers & hospitals financial incentives to meet quality markers for Medicare beneficiaries.
- reduce hospitalizations & institutionalizations
- to be eligible for shared savings, an organization must show improvement in quality measures in specific domains
- points have been assigned for 65 quality measures grouped into 5 domains
- patient/caregiver satisfaction
- care coordination
- patient safety
- preventive health
- management of at risk populations[2]
ACOs are responsible for care that a Medicare beneficiary receives even if the care is provided outside of the ACO (i.e. out-of-state care ...)[1]
ACOs are not responsible for Medicare part D benefits[1]
Additional terms
References
- ↑ 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012
- ↑ 2.0 2.1 2.2 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - ↑ Rosenthal MB, Cutler DM, Feder J. The ACO rules--striking the balance between participation and transformative potential. N Engl J Med. 2011 Jul 28;365(4):e6 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21751898
- ↑ <Internet> http://www.acponline.org/ppvl/policies/aco.pdf