DEFINING THE PHRASE: Accountable Care Organization

Defning the Phrase ACO

What is an Accountable Care Organization?

Use of the term Accountable Care Organization (ACO) was first noted in 2006 and, by 2009, it was widely understood in the healthcare community. An ACO is a group of healthcare professionals (physicians, hospitals, private practices, etc.) that voluntarily merge into a single entity in order to provide the highest quality, coordinated care for Medicare patients. An ACO is a healthcare entity responsible for improving the health of individuals and populations and their level of satisfaction with care, while simultaneously reducing healthcare spending.

The goal of an ACO is to have a payment and care delivery model by which reimbursement is contingent upon the quality of the care provided. This builds accountability into the model with the goal of reducing unnecessary medical procedures through better coordination which will ultimately lead to better outcomes for patients at a lower cost.

How do ACOs coordinate care?

All members in an ACO regularly communicate about a patient’s care plan so that care can be determined and coordinated to best fit the needs of the patient. When a patient sees a new doctor in a specialty area, time in the office is reduced because the important paperwork and medical information have already been shared in a common system. Additionally, because this information is shared, the chances of unnecessary repeated medical testing are reduced.
With a common information system, doctors can keep patients better informed about all aspects of their health, putting them in control of their care.

How can a healthcare provider join or establish an ACO?

In 2011, The US Department of Health and Human Services proposed guidelines for the establishment of ACOs. ACOs must have at least 5,000 Medicare beneficiaries as a patient base and providers willing to accept responsibility for the care of their patients for at least three years. According to the US National Library of Medicine National Institutes of Health, ACOs must also meet minimum requirements. A full and current list of requirements can found on the Centers for Medicare & Medicaid Services’ website.

Who qualifies to use an ACO?

ACOs accept patients who are in the Medicare program.

How can ACOs be successful?

In the years since 2011, established ACOs have outlined key factors that lead to success. First, it is vital to focus on, understand, and manage costs. There is tremendous space for shared savings in the ACO model, but to realize these savings, looking strictly at cost-per-service, is not effective. To accurately reflect the cost of care, calculations must include a wide range of factors.

Next, the data matters. Accurate analytics is critical for shared success. All participants in the ACO must work together to identify the important information, and every healthcare providers must accurately collect this data, every time. Any system is only as successful as its data. Increasingly sophisticated data sharing and analytics are required to serve all patients well in the modern healthcare landscape.

Finally, a proven system for effective care coordination is essential to the success of an ACO. Simply understanding the true cost of care and sharing data is not enough. To positively impact the lives of patients, the healthcare providers in an ACO must establish consistent processes and protocols for care coordination. Any participant in an ACO should be following the same procedures for coordination to assure the consistency and standardization needed to accurately measure outcomes. Built into this system should be the expectation of continuous improvement.

In summary, the goals of coordinated care are threefold. First, to deliver the best possible care to patients. Second, to improve the overall health of the community. And finally, to spend healthcare dollars wisely and lower costs through improvements to the system.
These goals can be achieved by accurately understanding health care costs, thoughtful data sharing and analytics, and standardization of procedures across the ACO. As we look to the future, we are moving away from a cost-per-service healthcare model and towards a more inclusive value-based healthcare model where outcomes are the final measure. ACOs are designed to play a fundamental role in that evolution.




About Behavioral Health Professionals, Inc.:

Established in 2002 and headquartered in Detroit, Michigan, BHPI is a Managed Behavioral Health Organization offering behavioral health services through a fully integrated network of world-class healthcare providers.  Our emphasis is on adding value for our customers by offering expert behavioral care management, medical coordination, chronic behavioral condition management. We are a fully accredited NCQA Managed Behavioral Health Organization (MBHO) & CARF Behavioral Health Business Network. BHPI offers collaborative solutions by building strong partnerships with health plans, health systems, community mental health organizations, and employer groups.   

For more information