Accountable Care Organization (ACO): Summary Points ACOs were included in healthcare reform, which requires healthcare providers (doctors, hospitals and others) to be more accountable for costs and quality. ACOs are expected to drive payment reform and changes in the way healthcare is delivered. ACO development will be driven locally, guided by government regulations based on successful case studies and pilots.
ACOs stem from the success of the Physician Group Practice (PGP) Demonstration, the first pay-for-performance initiative under the Medicare program. Physician groups proved they could improve quality, reduce costs and increase efficiency by proactively coordinating their patients' total healthcare needs.
ACOs are expected to make the healthcare experience more patient-centered and less fragmented. ACOs are anticipated to be the superstructure, or financial foundation, supporting the Patient-Centered Medical Home, a new care model.
ACOs will be designed to reduce silos between different providers, such as primary care doctors and specialists, nursing homes, mental health providers, home health and rehabilitation centers.
ACOs will work to create better digital linkages between healthcare providers for sharing of medical records, lab test results and X-rays.
ACOs will require a high level of clinical integration between inpatient and outpatient healthcare providers. This integration will enable family doctors, specialists, pharmacists and others to work more efficiently while improving the quality of care.
ACOs can be structured in a variety of ways, such as physician group practices, networks of individual practices, hospital-provider joint ventures, hospitals that employ physicians or other ways determined by the government.
ACOs will need to manage, track and measure information about individual patient health, the overall quality of healthcare the ACO delivers and financial performance.
ACOs will shift the emphasis of healthcare toward promoting health and disease prevention.
