An ACO, according to the glossary of terms published by the Office of the National Coordinator for Health Information Technology, part of the U.S. Department of Health and Human Services, is:
… a group of clinicians who have organized themselves in a way that enables them to take accountability for the overall quality of care and the total cost to payers of all or most of the healthcare services needed to a group of patients over a period of time.”
You won’t see “ACO” on a sign over a doctor’s or hospital’s door. But chances are the concept is shaping your healthcare experience today.
The origins of ACOs
The U.S. Centers for Medicare and Medicaid Services (CMS), the country's largest payer of healthcare services, has led the charge to motivate healthcare provider organizations to form ACOs.
They’ve invited providers – including SWHR – to agree to reimbursement based not on every single exam, test or procedure they perform but on how healthy they keep their patients – better care at a lower cost.
The idea has taken off. Many health insurers negotiate contracts with providers organized as ACOs to promise them “shared savings” when they prove that their patients are receiving better care (“the right care at the right time in the right place” is a familiar refrain) and staying healthier longer, as a result.
With value-based care replacing traditional fee-for-service care, Texas Health Resources and UT Southwestern created the SWHR ACO in 2016. Following the evolution of the “quadruple aim” concept, most ACOs see themselves as having four critical objectives.
The quadruple aim in healthcare
- Improve population health: Prevent and manage costly, chronic diseases.
- Reduce total cost of care: Improve resource utilization and reduce hospital admissions while assuming greater risk.
- Enhance the patient experience: Engage patients to play a greater role in their care decisions, thereby improving positive outcomes.
- Improve provider satisfaction: Deliver improved access to data and resources so providers within the ACO can focus more fully on patient care.
ACOs in action
Hopefully, you’ve experienced the benefits of the ACO movement yourself. Likely, you’ve noticed your primary care physician is committed to helping you:
- Schedule and show up for preventive care, including immunizations and cancer screenings recommended for your age range.
- Follow directions for taking prescribed medications and successfully managing chronic conditions, such as diabetes or hypertension (high blood pressure).
- Receive timely reminders and check-ins from nurses, therapists, pharmacists and other support staff who are committed to your well-being.
These practices have been proven to reduce the need for costly services, like emergency room visits or hospital stays and readmissions. Plus, the data supports that by following the recommendations of your primary care physician and related healthcare professionals, you can live better, longer.
A related term – clinically integrated network (CIN)
A clinically integrated network and an ACO are not the same but may share multiple characteristics.
An ACO benefits from the technology, leadership and patient support systems that clinically integrated networks form. Being a CIN puts an organization and its clinicians one step ahead in contracting with Medicare, Medicaid and private health insurers as ACOs.
