Hospitals, physicians, and other healthcare providers collaborate on your treatment as part of an accountable care organization (ACO Healthcare). They intend to provide you and other Medicare beneficiaries with better, more coordinated therapy. You have a better chance of receiving the care you require at the appropriate time when multiple specialists are collaborating to assist you.

When combined, they can prevent you from receiving unnecessary, expensive tests or treatments. And by working together, they avoid errors. If you suffer from a chronic condition like diabetes, high blood pressure, or cholesterol, ACOs may be of particular use to you.

How does ACO Healthcare work?

No matter where you receive your care, in hospitals, long-term care homes, or doctor’s offices, ACO providers are compensated for collaborating on your care. An ACO healthcare aims to ensure that you receive better care, particularly if you have diseases like diabetes or heart disease. ACOs enhance communication among all the healthcare providers involved in your care. Improved communication occurs between you:

• Both your primary care physician and your specialists.
• Physicians, hospitals, and providers of long-term care.
• Providers of healthcare as well as neighborhood services like Meals on Wheels.

ACOs will also help medical professionals and other healthcare providers. If treatment improves and costs less, money is saved. A portion of the savings is distributed to the healthcare providers in the ACO.

How does ACO Healthcare support Care Coordination?

To help with patient care coordination, healthcare professionals may collaborate to join an Accountable Care Organization (ACO healthcare). ACOs could include:

• Primary care physicians
• nursing professionals
• Medical assistants
• professionals
• drugstores
• Hospital Systems and Hospitals
• competent care facilities and home health organizations
• additional healthcare team members who provide and manage medical treatments and other supports

ACOs are intended to assist patients in navigating a challenging healthcare system and to place them at the center of their care. Individuals whose medical professional is an ACO healthcare member may receive:

• Additional assistance with chronic illness management.
• Coordination between several medical professionals or their care team members.
• More excellent preventative medical care to maintain their health.
• Extra assistance with their recovery when they leave the hospital.
• Care in more practical ways, such as in-home, telehealth, or other virtual settings.

Healthcare providers must usually use certified electronic health record technology to participate in an ACO. This technology can provide them with essential access to patient data at any time and place and facilitate the identification of potential issues before they worsen. For example, it can help identify dangerous prescription drug interactions that may occur when one doctor doesn’t know what another doctor has prescribed.

What advantages may an ACO offer you?

Reduced expenditures, better care:

Your ACO healthcare physicians can give you better care by exchanging information about your medical history and managing your care. Your health and avoidance of hospital stays will be the team’s top priorities. You will pay less out of pocket as a result.

Care coordination:

Suppose you visit two experts, one for heart problems and the other for diabetes. One physician may need to be made aware of what the other advises. You may take the same tests more than once. However, this is much less likely if you’re part of an ACO healthcare. Additionally, ACOs need a detailed plan to enhance your health, especially if you have several chronic conditions. A social worker, nurse, or a “care coordinator” may be assigned to you to help ensure you receive the necessary care.

Accountability from your healthcare providers:

ACOs hold your physicians accountable. They will be paid more if they can prove to Medicare that their patient’s health is improving. For example, an ACO must demonstrate that a team is handling your care. They must show you receive preventive care, such as a colonoscopy or a flu shot. Thirty-three quality criteria will be used to evaluate your ACO.

How would ACOs get their money?

Providers make more money under the traditional fee-for-service model when they do more operations and give patients more testing. According to experts, since this drives up prices, participants in an ACO healthcare would be offered incentives to reduce costs and fulfill quality criteria while emphasizing illness prevention.

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Conditions to join ACO Healthcare:

According to federal legislation, four categories of organizations can join an ACO.

• ACO Professionals: Physician assistants, nurse practitioners, clinical nurse specialists in group practice arrangements, physicians of medicine or osteopathic medicine, etc.
• Networks made up of ACO professionals’ separate practices.
• Collaborative ventures or partnerships between ACO specialists and hospitals.
• Hospitals that work with ACO specialists.

According to the Proposed Rule, the following entities are also eligible to be a part of ACOs.

• Providers or suppliers who aren’t hospitals or ACO healthcare professionals but are included under the Social Security Act (SSA).
• Hospitals with critical access.