What Is an Accountable Care Organization? A Plain-Language Guide for Medicare Patients
If you have Original Medicare, you may receive a notice saying that your doctor participates in an accountable care organization, or ACO. Many people are unsure what that means and whether it affects their coverage. This guide explains ACOs in plain language and answers the questions we hear most often at Advanced Health ACO.
The short answer
An accountable care organization is a group of doctors, and sometimes hospitals and other providers, who agree to work together to coordinate care for the Medicare patients they already serve. The goal is to make care more connected: fewer duplicated tests, better follow-up after hospital stays, and more attention to preventive care. Medicare ACO programs are run by the Centers for Medicare & Medicaid Services (CMS).
For people with Original Medicare, being seen by a doctor in an ACO does not change your Medicare benefits. You keep the same coverage, and you can still choose any doctor or hospital that accepts Medicare.
What an ACO is not
Because the term is unfamiliar, it is often confused with other things. An ACO is:
- Not an insurance plan. You do not enroll in an ACO the way you enroll in a Medicare Advantage plan.
- Not a network that limits your choices. With Original Medicare, you can see any provider who accepts Medicare.
- Not a change to your premiums or benefits. Those are set by Medicare and any supplemental coverage you have.
What participating practices actually do
The work of an ACO happens mostly behind the scenes. Participating practices commit to shared goals and shared reporting. In practice that includes:
- Care coordination: making sure the right follow-up happens after a specialist visit, test or hospital discharge.
- Preventive care: helping patients stay current on recommended screenings and their Medicare annual wellness visit.
- Chronic condition support: programs such as Chronic Care Management for eligible patients living with two or more chronic conditions.
- Quality reporting: measuring and reporting quality data to CMS so performance is visible.
You can read more about each area on our services page.
Data sharing and your choices
To coordinate care, ACOs may receive information from Medicare about the care you receive, such as visits, tests and prescriptions filled. This helps your doctors see care you received elsewhere. Medicare protects this information under federal privacy rules.
Medicare allows you to decline having your claims data shared with an ACO. To ask about that choice, or for any question about your Medicare coverage, call 1-800-MEDICARE (1-800-633-4227); TTY users can call 1-877-486-2048. Our information for Medicare beneficiaries page summarizes these rights.
Why ACOs focus on transitions of care
The days and weeks after a hospital stay are a vulnerable time. Medications may have changed, new symptoms can appear, and follow-up appointments are easy to miss. ACO practices put particular emphasis on contacting patients after discharge, reconciling medication lists and scheduling a timely follow-up visit with their own physician. These steps are simple, but they are where coordination makes the most practical difference.
How Advanced Health ACO fits in
Advanced Health ACO LLC is headquartered at 1370 E Venice Ave, Suite 102, Venice, FL 34285. It brings together independent cardiology and primary care practices in the Advanced Health Associates network, including locations in Venice and Sarasota. Patients continue to see their own physicians; the ACO supports those physicians with coordination, analytics and quality reporting. A list of participating locations is on our locations page.
For independent practices
Independent physicians often want the benefits of value-based care without giving up their independence. Joining an ACO can provide shared infrastructure, such as analytics, care coordination staff and reporting support, that is difficult for a single practice to build alone. If you run a practice and want to learn more, see our page for practices.
Transparency
Medicare ACOs are required to publish certain information publicly, including participants, leadership and, once available, quality and financial results. You can find this on our public reporting page.
Questions?
If you received a notice about Advanced Health ACO and have questions, call 941-412-0026 or use our contact page. For questions about your Medicare coverage itself, 1-800-MEDICARE is the best source.
This article is general information. It is not legal, insurance or medical advice.