The Centers for Medicare & Medicaid Services (CMS) describes Accountable Care Organizations (ACOs) as “groups of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.” Independent physicians may participate in an ACO as an option for the Alternative Payment Model. What is the relationship between the ACO structure and the current transition toward value-based care?
CMS is encouraging a move to value-based care and away from the fee-per-visit reimbursement model. The concept of value-based care emphasizes patient outcomes rather than the quantity of patient visits. Physicians who participate in ACOs are able to coordinate with other physicians in the group, spending their healthcare dollars more wisely, and realizing better cost-savings. As a result, they are able to provide higher quality care at lower costs.
As CMS describes them, ACOs are “patient-centered organizations where the patient and providers are true partners in care decisions.” Coordinated care and patient engagement are significant factors in the independent physician’s ability to provide value-based care. When patients become more involved in their own healthcare plan, they are more likely to see higher quality outcomes.
Coordinated care can result in fewer duplications and errors, improving the quality level of the care provided to each patient. For patients with chronic or complex conditions, the independent physician’s ability to coordinate with other providers is a crucial element of the patient’s healthcare strategy.
Moving forward with its value-based care initiative, CMS has introduced the Next Generation ACO Model, which offers “a new opportunity in accountable care—one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.” The Next Generation model is designed for those ACOs with more experience in coordinating care for populations of patients.