Accountable Care
Information for ACO Beneficiaries
What is an ACO?
Accountable care organizations (ACOs) are groups of doctors, hospitals and other health care providers who come together to provide coordinated care to their patients.
They provide you with a cohesive health care journey by communicating with each other. Medicare gives your health care provider’s ACO the opportunity to request certain information about your care. When your information is shared, it’s always secure.
The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. We want to get and keep you healthy and improve the care you receive.
As an ACO beneficiary, your health care providers always know what is going on with your health. So, you have less to worry about.
Freedom in Your Health Care
- There are many benefits to being a part of an ACO.
- Your health care providers can see the same test results, treatments and prescriptions.
- More coordination helps prevent medical errors and drug interactions.
- You may save time, money and frustration by avoiding repeated tests and appointments.
- You may be able to get care without a hospital visit through telehealth services or getting care at a skilled nursing facility.
- You get to choose the health care providers of your choice. Nobody can tell you which providers to see.
Please review the following resources for more information:
Your Privacy Is Very Important to Us
- Call 1-800-MEDICARE (TTY users, call 1-877-486-2048)
- Sign a form available in your provider’s office
- Sign a form mailed to you by your doctor
If you don’t choose to take any of the steps listed above, you may receive a letter from your doctor. This letter notifies you that your medical information will be shared automatically starting 30 days from the date you are notified.
Medicare won’t share information about anyone who has ever received treatment for alcohol or substance abuse without written permission. If you have received treatment for alcohol or substance abuse and want Medicare to share that information with your doctor’s Medicare ACO complete the “Alcohol or Substance Abuse Medical Data Sharing Form” and mail it in.
Contact Us
If you have any questions about being a beneficiary, please feel free to contact us by phone (888) 209-3761 or email PopulationHealthServicesandSupport@osfhealthcare.org .
For general questions or additional information about Accountable Care Organizations, please visit http://www.cms.gov and do a search using that term or call 1-800 MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Legal & Regulatory
Participation Waiver
OSF Healthcare System (“ACO”) participates in Medicare Shared Savings Program (“MSSP”) Enhanced, which qualifies as an Advanced Alternative Payment Model (“Advanced APM”) under the Quality Payment Program established by the Medicare Access and CHIP Reauthorization Act (MACRA).
As a result, providers / suppliers participating in the ACO may qualify as Qualifying Advanced APM Participants which makes them eligible to receive incentive payments, although the incentive payments will be paid to ACO’s affiliated participants (“ACO Participants”) to whom the providers / suppliers have reassigned their billing rights.
Pursuant to an arrangement approved by ACO’s Governing Body on March 7, 2019, ACO will pay certain physician independent contractors who qualify as Advanced APM Participants an incentive payment, if applicable, as described in the participating clinician agreement.
Results
An ACO is required by Medicare to report several quality metrics. The metrics are divided into these four categories:
- Patient and Caregiver Experience
- Care Coordination and Patient Safety
- Clinical Care for At-Risk Population
- Preventative Health
Below is a high level summary of OSF HealthCare quality scores since participating as an ACO in 2012.