Accountable Care Organizations (ACOs) are made up of doctors, hospitals, and other providers who cooperate to provide patients with access to high quality care. The goal of these organizations is to guarantee the patients receive proper care while avoiding unnecessary hospital visits and medical errors. In doing so successfully, everyone involved can reap the benefits.
Participating in an ACO is completely voluntary for providers. ACOs make providers accountable for the health of their patients while giving them monetary incentives to avoid unnecessary tests and procedures. For ACOs to work, the participators have to be able to willingly share information and patients. The providers, who manage to save money and provide the proper quality of service, will have access to a fraction of the savings.
It can be assumed that most providers will want to refer their patients to other providers within their ACO but it isn’t a requirement. Patients are free to use doctors outside the network as well without any additional costs. When a provider chooses to join an ACO, they must warn their patients and allow them the option of going to another provider and refusing to have their personal information shared within the ACO.
While most ACOs are part of the public sector, there has been a significant increase in privately created ACOs. Although they are not exactly part of the medical process, some of the country’s largest health insurers such as Humana, United Healthcare and Cigna, are forming their own ACOs in the private market. Insurance companies collect the data on patients that allow for them to report the results. So, while they aren’t engaged in the medical practices, they’re indeed important to the system.
Across the United States there are also some multi-specialty physician groups becoming private Accountable Care Organizations. By networking with nearby hospitals, they’re able to create their own ACOs and limit unnecessary spending for both the patient and the provider.
There are also many places where large systems are buying smaller physician practices with the plan of eventually becoming ACOs. These ACOs would directly employ almost all of their providers. Hospitals usually have more access to funds than doctors, so they’re able to easily finance the investment.
Private sector Accountable Care Organizations are popping up around the country. These organizations can increase savings for all participating parties while guaranteeing the best proactive care for the patient. Although participation is voluntary, providers everywhere need to be aware of their options and the changing world of medicine.
Author: Lauren Daniels