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:

Centers for Medicare & Medicaid (CMS) offer providers & hospitals financial incentives to meet quality markers for Medicare beneficiaries.

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. 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012
  2. 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
  3. 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
  4. <Internet> http://www.acponline.org/ppvl/policies/aco.pdf