What is an Accountable Care Organization (ACO)?

While the ACO concept continues to evolve, it can broadly be defined as:

“A group of health care providers who accept shared accountability for the cost and quality of care delivered to a population of patients.”

In an ACO, the group of providers who are collectively responsible for the care outcomes of a patient population enter into contracts with health insurance companies that reward them for improving quality and lowering total costs for patients over time.

Several strategies are imperative for successful ACO implementation, including:

  • An aligned physician network, with physicians integrated through Clinical Integration.
  • An IT infrastructure that facilitates exchange of patient information and identification of care improvement opportunities.
  • An optimal capacity strategy, including;
    • Providers that consistently deliver efficient, effective acute care episodes, and ensure reliable coordination, communication, and data sharing across the care continuum.
    • A coherent ambulatory network meeting three consumer demands: service affordability, on-demand access to care and a more tailored service approach
  • Transformed clinical operations, including standardized care pathways, emphasis on primary care, smooth care transitions, and patient activation.
  • Partnerships with payers willing to collectively reward all participants for better population management (e.g., payment bundles, shared-savings, global risk).

In an ACO, doctors, hospitals, and other health care providers can come together voluntarily to coordinate the care of a population. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

The various providers within an ACO need to work collaboratively with one another to provide coordinated care to the assigned beneficiary population, align incentives and lower overall healthcare costs. This is where CMG comes in. We will offer a full complement of services related to ACO management, including:

  • Data Analytics and Reporting
  • Clinical Integration and Quality Improvement Programs
  • Care Coordination Services
  • Admission and readmission management
  • High risk Patient identification and care management

If we are successful in maintaining quality and achieving savings on total cost, then we will earn a portion of those savings as additional reimbursement.

This is an exciting opportunity to expand our Value Based Reimbursement model. Our goal is to have our entire patient population under ACO models and to use the economies of scale this will generate to make these programs successful.