If it seems the new language common in the latest information from the Centers of Medicare and Medicaid (CMS) is a bit acronym-heavy, you’re not alone. With the new healthcare laws in place, some of which have no direct effect on Medicaid recipients, there was bound to be a bit of a shakeup in the language, products, and services. Accountable Care Organizations, or ACOs, aren’t necessarily new, but it’s important now that we understand what they are and what they mean for those receiving healthcare, and certainly Medicaid and/or Medicare, in the U.S. The new healthcare laws are heavy with the focus on ACOs.
CMS defines ACOs as:
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.
Sounds like a win-win for everyone involved, right? Even better, the goal of the team as a whole, is to provide the best coordinated care for patients so that they’re receiving the best care without so much wasted time with duplication of services. This, naturally, will also help prevent medical errors. This is especially important for those with lifelong medical needs.
It’s been successful, too. This, in theory, will help with healthcare budgets, the patients, and the government. For those on Medicare, there are several ACO programs. The Medicare Shared Savings Program is designed for program providers wishing to become an ACO. This is a solution that will benefit patients both in rural and suburban areas, while the Advance Payment ACO Model was designed for selected participants in the in the Shared Savings Program.
Remember, too, that there are many organizations across the nation have already incorporated ACO models, meaning the way they deliver care has already been developed on a patient-by-patient basis. Further, this is a voluntary program for doctors, hospitals, and other healthcare providers. The goal, however, is to ensure it’s a viable option so that patients have even better choices. As CMS states in its message to providers, “We want to try to meet you where you are. Our hope is to show you models of participation that will encourage you to participate in and begin this work, no matter your organization’s stage.” Remember, the better organized and functional the program is, the better it provides for its patients.
This means Medicare patients who are seeing those doctors and hospitals that are participating in an ACO will reap the benefits. That’s not to say if your current healthcare provider isn’t participating with an ACO, your service will lag or be “less than”, it simply means it’s a team effort designed to work for the needs of each patient, no matter their health requirements.
In the meantime, Medicare will continue to encourage this healthcare model for service providers, including bundled payments for care improvement, community based transition programs and comprehensive primary care initiative.
It’s clear the way healthcare is being delivered is changing and while no one knows for sure the dynamics of what those efforts may look like, the goal is to better protect patients so that they’re as independent and healthy as long as possible.
To learn more about Medicaid, Medicare or other elder law issues, contact our offices today.