Medicare Patients

No. If your affiliated physician is part of the Next Generation ACO, your benefits don’t change. An ACO is not a Medicare Advantage Plan (an HMO, PPO or another type of managed care plan). Your health coverage, premiums, and insurance arrangements are not affected.

No. You can use any doctor or hospital that you choose. You do not need to do anything or change your doctor.  You can continue to see the same physicians that you normally see. You are free to choose any doctor or hospital that accepts Medicare, at any time. Your primary care physician may continue to recommend that you see particular doctors for your specific health needs. However, it’s always your choice of what doctors, as well as hospitals, you choose.

Anyone with Original Medicare can participate. People with Medicare Supplement plans can also participate. Anyone with this type of coverage can contact an ACO directly, like the Southwestern Health Resources ACO, for information about services and participating.

Please contact your health plan regarding information about ACO participation.

No. There is not an additional cost to have care coordinated with providers through the ACO.

No. ACOs are held to high-quality standards, ensuring that savings are achieved through improved care coordination and care that is appropriate, safe, and timely. The Centers for Medicare and Medicaid Services (CMS) – the part of the U.S. Department of Health and Human Services that oversees ACOs -- evaluates the organizations on 33 quality measures relating to patient and caregiver experience of care, care coordination and patient safety, appropriate use of preventive health services, and improved care for at-risk populations.

ACOs share with Medicare any savings generated from lowering health care costs when they meet standards for high-quality care. Although cost savings are important, enhancing patient safety, efficiency and quality are compelling reasons for the success of an ACO.