What is an ACO?

A History of Mixed Results

The Affordable Care Act brought about the concept of ACOs more than a decade ago almost as an experiment. At this point, roughly half of all providers are participating in one. But the results have been uneven. ACOs started as a way for local physicians to work together and drive down the cost of care through improved coordination. Turns out, it takes some knowhow to run an effective ACO.

The Current Landscape

There are now more than 500 ACOs across the U.S. They were created to help physicians work together and create the scale required to venture into value-based care. But not all are focused on helping independent physicians generate shared savings and grow their practices. Some were made to lock providers into a health system’s network of specialists and facilities. Others were designed to sell third-party products to a captive audience.

The Big Question

What’s my financial risk?

Understand the payment models, incentives, and potential financial risks. Is the ACO participating in partial or full-risk contracts? And do you assume any downside risk? Many ACOs promise big numbers then charge hidden fees or require you to shoulder substantial risk. Make sure you understand your financial obligations from the get-go.

Don’t join an ACO without also asking these questions.

Who else is in the ACO network?

You may not be working side-by-side with many of these doctors. But they are your partners. Some ACOs blend high performers and low performers. You shouldn’t have to deal with doctors who aren’t pulling their weight. Ask if you can talk to some existing ACO members first.

How good is your data?

ACOs require data to perform. But data is only as powerful as the accompanying analysis and plan. Is the ACO’s data and technology compatible with your EMR or will you have to log in to a separate platform to connect the dots yourself? How will you know what to do with the data? You’re in charge of care, but a monthly data dump free of context won’t cut it.

How do I get paid?

It’s difficult to wait months and months to see how the shared savings shake out. How will your ACO ensure that your practice remains financially successful during the lean months?

Who is going to help me?

You need names. If an ACO is just going to hand you technology and data, leaving the rest to you, beware. You need assistance with coding your patients accurately, coordinating care (like scheduling Annual Wellness Visits) and managing complex patients.

You’re too busy to succeed at value-based care all alone.

Wellvana has answers ...

And high-performing ACOs that get results.

1. We’re a partner, not just a tech platform. You will know the nurses, medical assistants and coding experts helping you make value-based care work. And the amazing work they do doesn't hit your payroll.

2. Our ACOs are intended for the best of the best. Our rigorous, data-driven vetting process leads us to say no more than yes. You’ll be working with other high performers to ensure we hit our goal of double-digit shared savings.

3. Wellvana takes on the out-of-pocket downside risk. We’ve done our homework, and our providers have passed the test. That’s why we’re so confident they will perform. We take the risk. You share the rewards.

4. You’ll see data from far beyond your EMR — from hospital discharge feeds to government sources that help you understand your patients’ social determinants of health. Importantly, the data is fed to you directly on top of your EMR with clear action items related to closing care and coding gaps.

5. While we wait on the check from CMS, you get steady payments from Wellvana throughout the entire year helping to keep you flush and financially thriving.