An accountable care organization is a network of doctors and medical facilities that coordinate patient care with the goal of limiting unnecessary spending. Each ACO is responsible for providing care for at least 5,000 Medicare beneficiaries for at least three years. As such, an ACO is staffed to ensure that its patients can get comprehensive care in a holistic manner, where members of the organization have the tools to work together to avoid unnecessary treatments while still maintaining quality care.
In an accountable care organization, providers are incentivized to keep patients healthy, a departure from the previous system that pays out based on each provided service for the sick. To meet that end, practitioners are connected in a way that allows easy cooperation among them and smooth transfer of information back and forth. By treating patient health holistically, rather than in a task- and test-based environment, the patient should receive a more positive health care experience, and practitioners should save time that would otherwise be spent performing unnecessary tests.
Primary Care Physicians
The first point of focus in an ACO is the primary care physician -- the only must-have component of an ACO. The physician sees the patient and refers her to others within the ACO as needed. A primary care physician isn’t bound to a single ACO, nor is any other health care practitioner. Any member can belong to multiple ACOs and treat patients within these groups.
If more medical care is needed, the physician refers the patient to another doctor in the ACO. Therefore, an ACO generally offers as full a range of medical services as possible. Features such as electronic records systems allow each component to work together by streamlining the scheduling process and transferring needed information among providers. The goal is for information to be seamlessly shared throughout the network, so each physician in the chain has access to medical information about each patient.
Additional Staffing Needs
In addition to the primary care physicians and specialists, support personnel in an accountable care organization help make the structure work. Nurse care practitioners, for example, may be added to improve patient care and help an ACO hit its quality-of-care benchmarks. Private companies can become involved, such as drug stores that dole out prescriptions. Private ACOs can also include insurance companies, though these companies aren’t in charge of medical care.
- Kaiser Health News: FAQ on ACOs -- Accountable Care Organizations, Explained
- Healthcare Information and Management Systems Society: Accountable Care Organization -- Overview and ACO Pilots
- American College of Physicians: Joint Principles for Accountable Care Organizations
- Medicaid Transformation Issue Brief: A Brief Overview of Accountable Care Organizations