What is An ACO

An accountable care organization (ACO) is basically a group of healthcare providers, like doctors and hospitals, who come together voluntarily to provide coordinated care to a specific group of patients. The idea behind this is to ensure that patients, especially those with chronic conditions, receive the care they need in a timely manner. It also helps to prevent unnecessary duplication of services and medical errors.

The Centers for Medicare and Medicaid Services (CMS) introduced ACOs back in October 2011 through the Medicare Shared Savings Program (MSSP). ACOs that choose to participate in the MSSP agree to take on both financial and medical responsibility for a designated group of Medicare fee-for-service patients.

Since the development of the Medicare Shared Savings Program, CMS has introduced other types of ACO programs as well. These programs include the ACO Investment Model, the Next Generation ACO Model, and the Medicare-Medicaid ACO Model. So ACOs have expanded to serve patients covered by private or commercial payers, not just Medicare and Medicaid patients.

Now, let’s talk about why ACOs are important in healthcare. They play a crucial role in improving the quality of care and reducing healthcare costs. The whole idea behind this value-based, risk-sharing model is to achieve three main goals, also known as the “triple aim” of healthcare:

1. Improved patient satisfaction and experience.
2. Improved population health.
3. Reduced per capita healthcare costs.

Providers within an ACO have to meet specific benchmarks, and they are rewarded when they successfully maintain high-quality care while keeping costs low. When an ACO is successful in keeping their patients healthy and using healthcare resources wisely, they share in the savings they generate for the Medicare program.