Accountable Care Organization
Welcome to MedeAnalytics’ Accountable Care Organization Resource Center! This online resource provides a complimentary educational service to the healthcare industry.
The “accountable care organization” (ACO) is a major topic of discussion in American health policy. While many definitions of an ACO have been proposed, a general consensus has emerged, defining an ACO in simple terms as a voluntary group of physicians, hospitals and other healthcare providers that is willing to assume responsibility for the quality and cost of healthcare for a clearly defined population attributed to them on the basis of patients' use of primary care services. If the ACO meets quality benchmarks and reduces per-beneficiary spending below what would otherwise have been expected, it will receive a share of the savings.
Though the ACO label has been around since 2006, it was mentioned in numerous healthcare reform bills proposed in 2009 and was ultimately included in section 3022, the Medicare Shared Savings Program, of the Patient Protection and Affordable Care Act (ACA), which was signed into law on March 23, 2010. The ACA's ACO provision pertains to Medicare ACOs. The detailed ACO regulation has gone through an extensive rulemaking process, culminating in the release of the final rule on the Shared Savings Program on Oct. 20, 2011. Within the Shared Savings Program, the Centers for Medicare & Medicaid Services Innovation Center is testing the Advance Payment ACO Model, which is designed to provide additional support to physician-owned and rural providers who would benefit from added start-up capital to establish the needed infrastructure, e.g., additional staff or information technology.
In addition to the Shared Savings Program, an alternative ACO model, the Pioneer ACO Model, is an Innovation Center initiative designed to support organizations with a track record of operating as ACOs or in similar arrangements in providing more coordinated care to beneficiaries at a lower cost of Medicare.
It is important to note that prior to the passage of the ACA, there had been a number of private-sector efforts to form ACOs, initiated by physician-led health systems, integrated delivery systems, commercial payers and other types of organizations.
Commercial ACOs are distinct from Medicare ACOs in that a commercial payer, rather than Medicare, is the entity providing the financial incentives for quality and cost performance to the provider organizations.
Given the launch of the Shared Savings Program for Medicare ACOs and the wide variety of and increasing number of commercial ACO initiatives, we encourage you to visit this resource center often to keep abreast of the latest salient developments in the ACO area.
ACO Technology Framework
What are the technology components needed for both Medicare and commercial ACOs? MedeAnalytics has developed a framework that identifies the essential technology building blocks to support an ACO.
MedeAnalytics provides complimentary white papers on legislative and policy developments and other issues pertaining to ACOs.