Accountable care organizations (ACOs)
Advancing value-based care
Accountable care organizations (ACOs) can transform from the fee-for-service model to improve patient outcomes and reduce unnecessary costs.
Primary care is the foundation of the ACO model, which offers a framework for family medicine centered on providing accessible and effective health care to patients in an integrated, team-based setting. ACOs reward quality of care over volume of care.
What is an ACO?
An ACO is a group of health care providers, including primary care physicians, specialists, hospitals and extended-care facilities, that is held accountable for the cost and quality of care delivered to a defined subset of traditional Medicare program beneficiaries or other specific populations, such as commercial health plan subscribers.
An ACO can comprise almost any combination of group practices, practice networks, hospitals, hospitals employing other physicians and clinicians, hospital-physician joint ventures or virtual groups.
A key element for an ACO’s success is primary care physician leadership.
ACO fundamentals and objectives
The Patient Protection and Affordable Care Act (ACA) laid the groundwork for innovative approaches to health care delivery. Since the ACA’s adoption, federal and commercial insurers have worked to improve quality and lower costs by altering the incentives in their payment methods.
In 2015, Congress signed the Medicare Access and CHIP Reauthorization Act (MACRA) into law. MACRA repealed the sustainable growth rate (SGR) and established a payment system meant to transition away from fee-for-service (FFS) payment.
The tracks within MACRA aligned with ACOs are:
Advanced Alternative Payment Model (AAPM)
Merit-based Incentive Payment System Alternative Payment Model (MIPS APMs)
In these, the physician’s goal is to monitor and manage quality and cost.
Family physicians should work toward implementing and improving advanced primary care functions, including:
Increased access
Continuity of care
Coordination of care across the medical neighborhood
Risk-stratified care management
Planned care for chronic conditions and preventive care
AAFP advocacy for ACOs
The AAFP has been closely involved in developing the ACO model, working with private-sector payers as well as with CMS.
The Academy calls for ACOs that include:
Physician leadership, effective clinical integration and true partnerships among all participants
Voluntary participation by physicians and patients
Nationally accepted, validated clinical measures focused on ambulatory and inpatient care to monitor performance and augment efficiency and patient experience metrics
Integrated information systems that provide relevant information at the point of care and assist in coordination among clinicians across multiple transitions of care
Clearly defined organizational relationships, spending and quality benchmarks, and payment distribution mechanisms
Incremental implementation of ACO structures and payment systems
Optional participation in multiple ACOs by primary care physicians and sub-specialists
Effective incentives for patient engagement
Recent AAFP communications
Joint communications with other organizations
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