What Are ACOs and Why They Matter In Today's Healthcare Landscape

What is an Accountable Care Organization?

An Accountable Care Organization (ACO) is a group of health care professionals (including hospitals, primary care physicians, specialists and nurses) that work together as one team to coordinate care for a set group of patients across all settings of care. An ACO is responsible for managing the health of its patient group and the costs associated with providing care. The concept of an ACO is based on the premise that well-coordinated care can improve patients’ health and health care quality, while decreasing duplication of services, reducing risks of errors and complications and lowering costs. (Source: mhchealthcare.org)

The Centers for Medicare & Medicaid Services (CMS) reported earlier this week that three accountable care initiatives will grow and provide care to more than 13.2 million people with Medicare in 2023. More than 700,00 health care providers will participate in at least one of the three initiatives: the Medicare Shared Savings Program (MSSP) and two CMS Innovation Center accountable care model tests.

CMS has a goal of having all people with Traditional Medicare in an accountable care relationship with their health care provider by 2030. MSSP is the largest accountable care initiative in the country and is a permanent program in Medicare that was established by the Affordable Care Act. CMS expects that the policies finalized in the CY 2023 Medicare Physician Fee Schedule final rule will grow participation in the program for 2024 and beyond, when many of the new policies are set to go into effect. The majority of the growth is expected in rural and underserved areas and will promote equity. The number of beneficiaries assigned to ACOs participating in this program is expected to increase by up to four million over the next several years.

The ACO REACH Model aims to improve the quality of care for people with Traditional Medicare through better care coordination and by increasing access to accountable care in underserved communities. The model will test benchmark adjustments to shift payments to better support care for the underserved and enhanced Medicare benefits, INCLUDING CARE IN THE HOME. For 2023 the ACO REACH Model has 132 ACOs with 131,772 health care providers and organizations, providing care to an estimated 2.1 million beneficiaries. In addition, the model will have 824 federally qualified health centers, rural health centers, and critical access hospitals participating in 2023–more than twice the number in 2022. CMS said increasing the number and reach of ACOs in underserved communities will help close racial and ethnic disparities that have been identified among people with traditional Medicare in accountable care relationships.

Finally, the KCC Model focuses on coordinating care for Medicare beneficiaries with chronic kidney disease stages four and five and end-stage renal disease. In addition to care coordination, the KCC Model focuses on key areas of concern for this population, including delaying the onset of dialysis and increasing access to kidney transplantation so more patients can live fuller and longer lives. (Source: risehealth.org)