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 participants when performing above the Medicare established performance benchmark.
Performance year 1 has a weight of 10%, year 2 of 30%, and year 3 of 60%. Doctors are still paid on a Fee-for-Service basis under Original Medicare.
Advanced Premier Physicians ACO
Start Date: January 1st, 2015
La Palma Intercommunity Hospital, West Anaheim Medical Center, San Dimas Community Hospital, Montclair Hospital, and Garden Grove Hospital are in the process of creating a network of high quality care.