Accountable Care Organizations Aim For Improved Care

Opponents of the health reform law claim that the law will do nothing to lower costs, even as it would expand coverage, and they neglect to consider the law’s quality improvement provisions. The ACA’s many provisions to improve care and care coordination, and thus control costs, include Accountable Care Organizations (ACOs).

ACOs are organizations formed by groups of doctors and other health care providers that have agreed to work together to coordinate care for people with Medicare. The ACA created the Medicare Shared Savings Program (MSSP), and other initiatives related to ACOs. Federal savings from this initiative could be up to $940 million over four years, the Department of Health and Huma Services (HHS) has noted. Participation in an ACO is purely voluntary for providers and patients.

As of July 1, 89 new ACOs began serving 1.2 million people with Medicare in 40 states and Washington, D.C. These latest 89 ACOs announced by the Centers for Mediucare and Medicaid Services (CMS) bring the total number of organizations participating in Medicare shared savings initiatives to 154, including the 32 ACOs participating in the testing of the Pioneer ACO Model by CMS’s Center for Medicare and Medicaid Innovation (Innovation Center) announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. In all, as of July 1, more than 2.4 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives.

These 89 new ACOs have entered into agreements with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care. “Better coordinated care is good for patients and it saves money,” noted HHS Secretary Kathleen Sebelius. “We applaud every one of these doctors, hospitals, health centers, and others for working together to ensure millions of people with Medicare get better, more patient-centered, coordinated care.”

“This new group of ACOs adds to a solid foundation,” said CMS Acting Administrator Marilyn Tavenner. “The Medicare ACO program opened for business in January and, already, more than 2.4 million beneficiaries are receiving care from providers participating in these important initiatives.”

To ensure that savings are achieved through improved care coordination and care that is appropriate, safe, and timely, an ACO must meet quality standards. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.

Even private insurers have adopted the ACO concept, as a recent Chicago Tribune article pointed out. The Tribune article announced two Chicago area medical organizations among the 89 most recent Medicare-participating ACOs, and one of these organizations in January 2011 joined with a major insurer to form a commercial ACO.