Why would physicians join an Accountable Care Oragnization (ACO)? This informative slide presentation gives a brief overview of ACOs, their benefits, and four reasons physicians may have for joining one.

1. ACCOUNTABLE CARE ORGANIZATIONS:
4 PHYSICIAN BENEFITS

2. REVIEW:
WHAT IS AN ACCOUNTABLE
CARE ORGANIZATION?

3. The Affordable Care Act established
provisions for accountable care
organizations (ACOs) as one of several
approaches to moving payment models
from fee-for-service.

4. An ACO is a group of community physicians,
hospitals and other clinicians that come
together to coordinate care as a healthcare
organization.

5. ACOs operate under a payment and care
delivery model in which provider payments
hinge on certain quality benchmarks and
reductions in the growth of the total cost of
care for an assigned population of patients.

6. The group of care providers, which can include
primary care providers, specialists and other
heathcare service providers, share in the
responsibility of meeting and reporting quality
benchmarks as well as focusing on prevention
and chronic disease management.

7. Incentives for participating in an ACO
come in the way of shared savings (i.e.
reductions in the growth of the total cost
of care for an assigned population of
patients).

8. The Medicare Shared Savings Program
shares the savings of ACO effort between
the ACO & CMS (the providers continue to
receive Fee for Service payments at this
time).

9. To earn shared savings, providers must
provide detailed documentation across all
four domains of quality:
1) quality standards on patient experience
2) care coordination and patient safety
3) preventive health
4) at-risk populations

10. Providers are eligible for the shared
savings based on how they perform in
33 quality measures in the second and
third performance years.

11. WHY ARE ACOs
IMPORTANT?

12. HHS estimates that ACOs could save
Medicare up to $940 million in the first
four years.

13. 20% of ACOs are community health
centers, rural health clinics, and critical
access hospitals that serve low-income
and rural communities.

14. 25-31 million patients – roughly 10% of
the US population – are affected by an
ACO in some way.

15. 92.6% of payers report looking at ACO
participation, while 91.5% of providers say
they are considering participating.

16. WHY WOULD PHYSICIANS
JOIN AN ACO?

17. 1. Ease of Entry to Value-Based Payments
Value-based payments ARE coming whether a
provider joins an ACO or not. Medicare has
created a roadmap for ACOs which eases the
way into the value-based system without losing
money or violating anti-trust laws.

18. 2. Patient Retention & Loyalty
Patient retention and loyalty is key to any
provider’s success. When patients receive well-
managed care and experience better outcomes,
they are far more likely to stay loyal to their
provider.

19. 3. Physician-Determined Risk
The Medicare incentives offer ACOs the ability to
earn incentives at different levels depending on
the amount of risk the organization is willing to
take on.

20. 3. Physician-Determined Risk (cont.)
ACOs under the “one-sided” payment model of
the Medicare Shared Savings Program are:
• Still compensated on a fee-for-service basis
• Eligible for bonuses of 50% of the shared
savings
• Not required to assume financial risk of cost-
of-care increases throughout a three-year
contract period

21. 3. Physician-Determined Risk (cont.)
ACOs under another model of the Medicare
Shared Savings Program are:
• Eligible for bonuses of 60% of the shared savings
• Responsible for paying back government for cost
overruns
• Required to assume financial risk of cost-of-care
increases

22. 4. Revenue Gains
CMS estimates the average ACO will recoup its
expenses by a ratio of 2.9, meaning that if the
ACO spends $3 million to become established
and to be maintained then it should earn $5.7
million in profits.

23. INTERESTED IN LEARNING
MORE?

24. LEARN MORE ABOUT ACO
ACCREDITATION:
http://www.successehs.com/item/what-is-
aco-accreditation.htm