What the Heck is an ACO?

Three words: Accountable Care Organization. While your head may be spinning at just the mere mention of this health care topic, don’t give up. Yes, it can be difficult to understand, but we hope, through this story and future stories, to decode the puzzling nature of an ACO.

Beacon Health System became a participant through CHA ACO in an ACO at the start of 2014. It’s going to change how health care is organized, delivered and financed for years to come. So before we go any further, let’s figure out what it is: An ACO is a group of providers who coordinates care for their Medicare patients so that they get the right care at the right time in the right place.

ACOs aim to eliminate these problems by enhancing the partnership between doctors and patients in making health care decisions. As a result of CHA’s ACO, Medicare beneficiaries will have more control over their health care and physicians will provide better care because they will have access to their patients’ medical history and communicate more effectively with a patient’s other doctors. So when an ACO provides high quality-care, avoids duplication of tests and prevents medical errors, there is a health care savings and Medicare shares that with an ACO.

Beacon took big step forward in providing more coordinated care for our patients by becoming a participant in an ACO. The official name is CHA ACO, LLC and it took effect on Jan. 1. Beacon owns 50 percent of CHA and it is a physician hospital organization, which has physicians and hospitals working together on managed care issues, such as utilization management, quality improvement and reimbursement.

To better understand why it’s important Beacon became a participant in an ACO, below is a list of frequently asked questions.

What is the goal of an ACO?

Rather than a fragmented, uncoordinated system, an ACO enhances the framework of care and how care it is delivered. Who makes up CHA ACO? It has 307 providers, two hospitals (Memorial Hospital of South Bend and Elkhart General Hospital) and Beacon Health Ventures as contracted providers for 2014.

 Who is part of the CHA ACO?

Nearly 14,000 Traditional Medicare beneficiaries. Medicare patients don’t sign up for an ACO. If their physician is part of an ACO, they will be included. Patients can place limitations on if they want their information shared with their doctors. However, to help physicians who participate in an ACO give patients the best possible care, health care providers encourage patients to share some additional information. This information helps physicians track the services patients have already received and understand where they may need more care.

 What are the benefits to the patient to participate in an ACO?

•  Patients don’t have to fill out as many medical forms that ask for the same information.
•  Health care providers will all know what’s going on with the patient’s health because they communicate with each other.
•  Patients don’t have to have the same medical tests done over and over because their results are shared among the health care team.
•  Health care providers become partners with patients in making care decisions.

 Can a patient decide not to share information?

If a member chooses not to share their information with the ACO, they will need to fill out the declination letter in the provider office, and the provider will forward it to CHA ACO, or the member may call 1.800.MEDICARE to make the request.

Do you want to know more?  Call CHA ACO at 574.647.1266  or visit chanetwork.com/chaaco.