Accountable Care Organizations have existed for more than a decade, but the role of an ACO remains widely misunderstood. This handy guide hits the high points.

FAST FACTS

• 1 in 5 Medicare patients are now served by an ACO with CMS pushing for 100% by 2030.

• $1.8 billion Medicare savings from ACOs in 2022, continuing a 6-year streak of reducing costs.

• 700,000 providers participate in an ACO, with 63% receiving shared savings. 

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ACCOUNTABLE — Physicians take responsibility for their patients and are rewarded for it.  

• The 2010 Affordable Care Act brought about the ACO as part of a larger strategy to reduce runaway costs. The entities are charged with helping physicians improve care and lower costs for Medicare, Medicaid and commercial health plans.  

• The financial risk shifts from health plans to providers themselves. With skin in the game,  
  doctors have more incentive to, for example, fit in same-day appointments instead of sending  
  a patient to the ER. They avoid ordering redundant tests or unnecessary specialist visits.  

• At first, ACOs only saw upside, like a bonus. Now ACO REACH offers full-risk tracks.  

• If Medicare thinks it will cost $12,000 to care for Mrs. Jones and with better coordination it costs $9,000, full-risk providers and their ACO keep the difference — so long as they also hit quality metrics.   

• But the ACO can also lose — and many do. If this fictional patient costs $20,000, the full-risk ACO funds the overage. That’s how Medicare and other payors benefit. 

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CARE — Care constantly improves because ACOs can’t win unless patients and providers win first.   

• Put simply: primary care doctors become the quarterback of care, and wellness rules.   

• ACOs can help providers with remote nurses to manage complex patients between appointments and assist after hospitalizations.   

• Some ACO operators, like Wellvana, have even hired pharmacists to reconcile prescription medications and social workers to guide patients struggling with social determinants of health like transportation.  

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ORGANIZATION — Providers work as a team, even on other sides of the country.  

• Initially, ACOs were mostly linked to health systems and focused on keeping patients within their networks.   

• Increasingly, the most successful ACOs are made up of independent physicians, led by organizations that are in the business of value-based care.   

• While ACOs do need a local network of like-minded specialists to succeed, a single ACO can have primary care providers scattered from coast to coast.   

• To distribute the financial risk, CMS calculates savings rates collectively, promoting shared accountability.

• Bottom line: ACOs prioritize the doctor-patient relationship — the way medicine is meant to be.   

Are you a doctor interested in joining a Wellvana ACO? See how your practice could perform by using our calculator. https://wellvana.com/calculator