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. The goal of an ACO is to ensure that patients, especially those with chronic conditions, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When your primary care provider is part of an ACO, it can offer you several additional benefits aimed at improving your healthcare experience and outcomes.
Enhanced Benefits You Can Receive Through ACOs
Being part of an ACO can provide Medicare patients with access to expanded services and more coordinated care. One notable benefit is the potential for expanded telehealth services. Depending on the ACO your provider participates in, you might be able to access certain medical services from the comfort of your home. This can include real-time communication with your healthcare provider using technology like your smartphone or computer. Telehealth can be particularly beneficial for routine check-ups, medication management, and discussing health concerns without needing to travel to the doctor’s office. It’s worth asking your provider directly if they offer telehealth services through their ACO.
Another significant advantage within some ACOs is the waiver of the 3-day hospital stay rule for skilled nursing facility or rehabilitation care. Typically, Medicare requires a 3-day hospital stay before a patient can be admitted to a skilled nursing facility for rehabilitation. However, if your doctor or provider is part of an approved ACO, they may be able to send you directly to a skilled nursing facility or for rehabilitation care even without the prerequisite 3-day hospital stay. To be eligible for this, your healthcare provider must determine that you require skilled nursing facility care and that you meet specific eligibility criteria. This benefit can be particularly helpful for patients who need post-acute care but can avoid a hospital stay, allowing for a smoother transition to the necessary care setting.
Coordinated Care and Information Sharing within ACOs
A core principle of ACOs is to improve the coordination of patient care. To facilitate this, ACOs enable better communication and collaboration among your doctors and other healthcare providers. Medicare supports this coordination by allowing your healthcare provider’s ACO to request and securely access data about your care. This secure sharing of your health information ensures that all members of your care team have the necessary insights to provide you with the most appropriate and effective care. By having a comprehensive view of your medical history and current needs, your providers can work together more effectively, leading to better health outcomes and a more streamlined healthcare experience.
It is important to note that Medicare prioritizes the privacy of your health information. If you have concerns about Medicare sharing your information with your healthcare providers for care coordination purposes, you have the option to opt out. You can do this by calling 1-800-MEDICARE (1-800-633-4227). Even if you opt out of sharing for care coordination, Medicare may still share general, de-identified information to assess and measure the quality of care provided by different providers and organizations. For more detailed information regarding how Medicare may use and disclose your health information, you can visit Medicare.gov and search for “privacy.”
In conclusion, Accountable Care Programs, through ACOs, offer a pathway to enhanced and more coordinated healthcare for Medicare patients. From expanded telehealth options to streamlined access to post-acute care and improved communication among healthcare providers, ACOs are designed to put the patient at the center of a high-quality, efficient, and patient-centered healthcare system. If your primary care provider is part of an ACO, understanding these benefits can help you take full advantage of the coordinated care and services available to you.
