New Accountable Care Program Initiatives for Medicare
The Center for Medicare and Medicaid (CMS) recently announced three new initiatives – Accountable Care Organizations (ACO) – designed to encourage better coordination of health care services by practitioners and hospitals.
“The goal is to correct how government programs such as Medicare provide reimbursement,” suggests Alan Weinstock, an insurance broker at MedicareSupplementPlans.com. “By rewarding medical providers for quality rather than quantity of care, experts predict that the Medicare program could save as much as $430 million in just three years.”
Three ACO Initiatives
The CMS introduced the ACO as a way to help doctors, hospitals and other health care providers to better coordinate care for Medicare patients. They are being established as part of the Medicare Shared Savings Program which is meant to promote accountability for patients and coordinate services under Medicare Parts A and B. The intent is to encourage investment in infrastructure and redesigned care processes in order to encourage high quality and efficient delivery of services.
The three new initiatives will be run by the CMS Innovation Center and include:
a. Pioneer ACO Model is for organizations that already coordinate care. It allows up to 30 organizations to apply to become ACOs this fall and is designed to achieve cost savings for Medicare, employers and patients. To accomplish this goal they will be expected to improve the health care and experience for individuals, improve the health of populations, and reduce the growth rate of health care spending. They will be held financially accountable for the care they provide to their beneficiaries.
b. Advanced Payment ACO Initiative allows specified organizations to access their savings up front to invest in care coordination. Some providers have expressed concern about their lack of access to the capital they need to invest in tools and staff required for care coordination. A plan for using the funds would be required.
c. Free Accelerated Development Learning Sessions is meant to teach health care providers how to improve and coordinate care and delivery.
Patient and provider participation in an ACO is purely voluntary.
Purpose of Utilizing ACOs
The expectation is that those health care providers who choose to participate in an ACO will work together in an effort to coordinate patient care by tracking Medicare patients’ conditions and treatments, regardless of where the patient receives services. This way each patient’s medical history will be a matter of record, not memory.
In addition, ACO providers would then be able to coordinate their Medicare patients’ care regardless of which doctor, hospital, lab or other health care facility provided services. This would be a big step toward eliminating duplication, medication errors, and ultimately mismanagement, while saving time and money.
It would be the ACO’s responsibility to put into place the proper processes that would promote treatments and procedures based on best medical practices. Beneficiaries still would be able to obtain their regular Medicare fee-for-service benefits, such as annual wellness visits and preventive screenings.
Medigap insurance can give what the original Medicare Supplement cannot and this is a very effective advantage of the Medigap insurance California.
Processing your request, Please wait....
