Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other healthcare providers who come together voluntarily to give coordinated high-quality care to their Medicare patients. The goal of an ACO is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When your primary care provider is part of an ACO, you may gain access to a range of additional benefits designed to improve your healthcare experience.
One significant advantage of an ACO program is the potential for expanded telehealth services. Depending on the ACO your provider participates in, you might be able to utilize technology like smartphones or computers for real-time communication with your healthcare provider from the comfort of your home. These telehealth options can increase convenience and access to care, particularly for routine check-ups or follow-up appointments. To find out if your provider offers telehealth services through their ACO, it’s best to ask them directly.
Furthermore, ACO participation can streamline access to skilled nursing facility or rehabilitation care. Ordinarily in Medicare, a prior 3-day hospital stay is typically required before a patient can be admitted for skilled nursing care. However, doctors or providers within certain ACOs have the authority to send patients directly to skilled nursing facilities or rehabilitation, even without the 3-day hospital stay. To be eligible for this benefit, your doctor must determine that you require skilled nursing facility care and that you meet specific eligibility criteria. This can be particularly beneficial for patients needing immediate post-acute care without the need for hospitalization.
If your primary care provider is involved in an ACO and you are enrolled in Original Medicare, you should receive written notification about their ACO participation. Additionally, you may notice posters in your provider’s office informing patients about their ACO. Across the nation, there are now hundreds of ACOs working to improve patient care.
A core function of ACOs is to enhance communication and care coordination among your healthcare team. To facilitate this, Medicare may provide your healthcare provider’s ACO with access to data related to your care. This secure data sharing ensures that all members of your care team have the necessary information to provide you with the most effective and well-coordinated care possible. This improved communication can lead to better health outcomes and a more seamless healthcare experience.
Medicare is committed to protecting the privacy of your health information. If you have concerns about Medicare sharing your information with your healthcare providers for care coordination within an ACO, you have the option to opt out. You can do so by calling 1-800-MEDICARE (1-800-633-4227). It’s important to note that even if you opt out of data sharing for care coordination, Medicare may still share general information to assess provider quality and program effectiveness. For more detailed information about Medicare’s privacy practices, you can visit Medicare.gov and search for “privacy.”
