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accountable care organization (ACO)
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]
- diabetes mellitus
- heart failure
- coronary artery disease
- hypertension
- COPD
- frailty
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]
Related
Medicare
References
- Medical Knowledge Self Assessment Program (MKSAP) 16
American College of Physicians, Philadelphia 2012
- 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
PMID: 21751898
- http://www.acponline.org/ppvl/policies/aco.pdf