Quality & Practice

Accountable Care Delivery Models

Accountable Care Organizations (ACOs) have actually been available for some time, but have grown tremendously in number since Medicare decided that the ACO would be a good method to control costs without compromising the quality of the care being given.

On their website, CMS describes ACOs as follows: “Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.” 

One can pick out the defining characteristics of an ACO from the above quote – groups of providers, voluntary, coordinated care, high quality care, and savings in cost.  The group of providers has come together and agreed to accept a different sort of reimbursement than would otherwise be the case. By making one group of providers responsible for coordinating and providing a patient’s care, the hope is that there will be better quality accompanied by decreased costs.  For example, an ACO may be set up with 24/7 availability for patients to reach a medical professional, reducing the chance that a patient may go to the emergency room if some new health concern pops up in the middle of the night.  This will decrease costs by avoiding an expensive ED visit, while at the same time providing continuity of care by the patient’s usual physician and team, likely resulting in higher quality for the patient.

Medicare offers several different ACO models within the category of Accountable Care.  For additional information on how they differ from each other, please click on the links below.  These include:

The ACO model is a good example of the difference between payment reform and delivery reform models.  One of the reformed payment models used in  some ACOs is known as “shared savings” because, if the ACO is able to provide care that meets all of the quality measures and is able to decrease the overall cost, they will receive part of the money saved (the ACO and CMS are sharing in the savings).  The delivery reform model is the ACO itself, which seeks to achieve shared savings and increased value by the way in which it delivers the care through a group of providers who have agreed to coordinate care.