Accountable Care Organizations (ACOs) are networks of doctors, hospitals, home health and providers serving Medicare Fee-For-Service patients. Any Medicare provider can join if measures defined by the ACO and Medicare are met.
An ACO has benefits for providers and patients, but is challenging for providers to successfully execute. In this article, we’ll discuss why it’s crucial to create blueprints for successful ACO participation.
Benefits of ACO Participation
The goal of ACO’s is improvement in care with decreased cost. With healthcare providers working together, patients experience complete, seamless care alleviating unnecessary emergent care and hospitalizations. Successfully collaborating in an ACO benefits your agency from an organizational and financial standpoint. Medicare gives ACO members with positive outcomes additional reimbursement.
Preparing for ACO Participation
ACO membership isn’t simple and agencies must evaluate process measures. There are quality measures and outcomes required for participation. Once you’ve joined, the ACO must maintain and improve benchmark data to receive financial perks. Here are criteria of an ACO.
To participate, agencies should know how Medicare defines an ACO. Here are a few stipulations:
See at least 5,000 Medicare Fee-For-Service patients;
Three year participation minimum;
Be in good standing with Medicare;
No other participation in shared reimbursement plans with Medicare.
ACO’s also require a governing body responsible to promote use of evidence-based medicine, patient engagement, and quality and cost reporting.
Once your agency meets initial outcome measures, the ACO as a whole must exceed Medicare benchmarks to maintain additional financial reward. Benchmarks developed by CMS measure ACOs for outcomes and cost savings . If savings are discovered, Medicare shares a portion with participating providers. This means you must ensure staff is well-trained and communicates with other providers in the ACO. Successful collaboration decreases duplication of care and testing, emergent care visits, hospitalizations, and ultimately cost.
Kenyon HomeCare Consulting
It’s clear joining an ACO benefits your agency, but getting there is a challenge. At Kenyon HomeCare Consulting, we know the steps you’ll take to succeed in an ACO. Schedule a consultation to get started.