What is an Accountable Care Organization (ACO) and the benefits?

The development of an accountable care organization, like Adirondacks ACO, is a key component of health care reform and a shared commitment by participating providers to provide high quality individualized care, delivered close to home, coordinated for safety, effectiveness, and lower cost, for the benefit of the patients and families we serve.

An accountable care organization (ACO) is a coordinated group of health care providers who have agreed to share responsibility for the care of a defined population of individuals. The Medicare Payment Advisory Commission defines an ACO as: a group of primary care providers, specialists and/or hospitals and other health professionals who coordinate the full continuum of care and are accountable for the overall quality of care and costs for a defined population. (Medicare Payment Advisory Commission). ACO providers coordinate amongst themselves, and with each individual, to improve the individual’s quality of care, the efficacy of the care and to reduce the rate of increasing cost of care over time.

Coordinated care helps ensure that patients, especially those with chronic conditions, get the right care, at the right time and in the right place. An ACO is not a health insurance plan nor a health maintenance organization (HMO). An ACO doesn’t affect Medicare benefits or which providers a patient can choose to see. ACOs put the doctor and patient in charge of patient care, not insurance companies. Being part of an ACO is about better collaboration between providers and a shared commitment to improving the health of the patients they serve.

For network providers and hospitals, Adirondacks ACO represents an opportunity to develop the clinical and business relationships that will enable all member health care organizations to be successful in the accountable care environment. This is a significant first step in moving away from a fee-for-service reimbursement model to one in which providers are accountable for coordinating the health of a defined population in a way that doesn’t change the program for Medicare beneficiaries or expose providers to financial risk from Medicare. To do well will require a focus on quality, keeping people healthy, and developing an integrated system of care statewide. If successful, this statewide system will lead to improved value in the care we deliver to our Medicare beneficiaries.