Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other healthcare providers who come together voluntarily to give coordinated high-quality care to their Medicare patients. A key component of this coordinated care is a care management program designed to ensure you receive the right care at the right time, especially if you have chronic conditions or complex healthcare needs. If your primary care provider is part of an ACO, you may gain access to enhanced services and benefits through these programs, aimed at improving your health outcomes and overall healthcare experience under Medicare.
One significant advantage of care management programs within Medicare ACOs is the potential for expanded telehealth services. These programs recognize the importance of convenient and accessible healthcare. Depending on the ACO your provider participates in, you might be offered telehealth options. This allows you to consult with your healthcare provider from the comfort of your home using technology like your smartphone or computer. Telehealth can be particularly beneficial for routine check-ups, medication management, and follow-up appointments, saving you time and travel while still receiving quality care as part of your Medicare care management program. It’s worth asking your provider directly if they offer telehealth services under their ACO affiliation.
Furthermore, Medicare care management programs within ACOs can sometimes provide waivers for certain requirements, streamlining access to necessary care. For example, under normal Medicare rules, a 3-day hospital stay is typically required before Medicare will cover care in a skilled nursing facility. However, if your doctor or provider is part of an ACO and enrolled in a care management program, they may be approved to send you directly to a skilled nursing facility or rehabilitation care without this prior 3-day hospital stay. To qualify for this valuable benefit, your healthcare provider must determine that you require skilled nursing facility care and that you meet specific eligibility criteria within the care management program. This flexibility can be crucial for timely and efficient transitions to post-acute care, contributing to better recovery and health management.
Effective care management programs rely heavily on coordinated care. ACOs facilitate this coordination by enabling your doctors and other healthcare providers to communicate and share information securely. Medicare supports this by allowing your healthcare provider’s ACO to request data about your care. This secure data sharing ensures that all members of your healthcare team have the necessary information to provide you with well-informed and cohesive care within the care management program. This improved communication and coordination is a central aim of ACOs and their associated care management programs, leading to more seamless and patient-centered healthcare.
It’s important to know that while data sharing is crucial for effective care management programs, Medicare prioritizes the privacy of your health information. If you have concerns about Medicare sharing your information with your healthcare providers for care coordination within an ACO, you have the option to opt out. You can do so by calling 1-800-MEDICARE (1-800-633-4227). Even if you opt out of data sharing for care coordination, Medicare may still use general information to assess and improve provider quality. For more detailed information on Medicare’s privacy practices, you can visit Medicare.gov and search for “privacy.”
If your primary care provider participates in an ACO and you are enrolled in Original Medicare, you will receive written notification about their ACO participation. You’ll also typically see a poster in your provider’s office informing you about their involvement in an ACO. With hundreds of ACOs now operating across the country, these care management programs are becoming increasingly accessible, offering enhanced benefits and coordinated care for Medicare beneficiaries.
