What is an ACO?
It is a Medicare Shared Savings Programs (MSSP) that serves patients with Medicare Part A and Part B in
which providers unite to give coordinate care to Medicare Patients. By reducing costs and providing
effective care, CMS will share the savings with the ACO.
– ACOs are NOT HMO Plans.
– Still Medicare Fee-for-Service (no authorization hassle). Providers control the diagnosis and treatment decisions.
– ACO have an agreement with CMS, not with health plan.
– More revenue comes from shared savings received from Medicare.
– Patients free to seek services/providers outside of ACO network.
How does the ACO Model reward providers?
Medicare shares the savings attained by ACO participants at the end of the performance year when the ACO performs above the Medicare established performance benchmark. Levels A and B are one-sided models (savings only) with shared savings up to 40% based on quality performance; not to exceed 10% of updated benchmark (ACO needs to attain at least 25% savings to receive maximum shared savings). Levels C to E are two-sided models (risk/reward) with shared savings up to 50% based on quality performance; not to exceed 10% of updated benchmark (ACO needs to attain at least 20% savings to receiving maximum shared savings).
Providers are still paid on a Fee-for-Service basis under Original Medicare.