WHAT IS AN ACO?
Accountable Care Organizations
An Accountable Care Organization (ACO) is a group of healthcare providers, such as doctors, hospitals, and other healthcare professionals, who voluntarily come together to be accountable for the quality, coordinated care and the costs of “traditional” Medicare patients (e.g. fee for service) that they serve. The goal of an ACO is to promote the quality and value of healthcare services, especially to chronically ill patients, by avoiding unnecessary duplication of services, reducing medical errors, and improving care coordination. ACOs are required to have processes to coordinate care, promote evidence-based medicine and patient engagement, measure and report on quality and cost measures, and demonstrate patient-centeredness. ACOs that are successful in meeting program guidelines and established goals, earn a portion of the savings that accrue to the Medicare program.
FAQs
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The Medicare Shared Savings Program (MSSP) and Accountable Care Organization (ACO) are related but distinct entities within the Medicare program.
MSSP is a payment model within Medicare that rewards eligible providers for delivering coordinated, high-quality care and achieving cost savings. ACOs, on the other hand, are groups of healthcare providers who come together to provide coordinated care and may participate in MSSP to receive shared savings payments.
MSSP is a program established by the Centers for Medicare & Medicaid Services (CMS) that encourages eligible providers, hospitals, and suppliers to collaborate in delivering high-quality, coordinated care. It is a payment model that rewards participating entities for achieving better health outcomes and reducing costs. MSSP aims to shift the focus from volume-based care to value-based care, promoting care coordination and more efficient healthcare services.
On the other hand, an ACO is a group of healthcare providers who voluntarily come together to provide coordinated care to Medicare fee-for-service patients. These providers, such as doctors, hospitals, and other healthcare professionals, collaborate to improve care quality, reduce medical errors, and avoid unnecessary duplication of services. ACOs can participate in MSSP, and if they succeed in delivering high-quality care and achieving savings, they may be eligible to receive shared savings payments from the Medicare program.