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What "accountable care" can do for you.

A growing number of physicians re starting to take part in accountable care organizations (AC0s), which are groups of doctors, hospitals and other health care providers who voluntarily come together to offer coordinated, high-quality care to Medicare patients. A 2013 Medscape study of more than 21,000 doctors found that 24 percent were either in an ACO or planned to be in an ACO within a year, compared to only 8 percent of physicians in the 2012 report. ACOs are relatively new programs driven by changes in federal health care policy They represent a shift in how health care providers work together, says Jeffrey Farber, MD, a geriatrics and palliative medicine specialist at Mount Sinai.

"Joining an ACO is a big change for doctors," Dr. Farber says. "They are transitioning from our long-standing fee-for-service model of health care reimbursement to a system that rewards high-value over high-volume health care. Doctors will need to learn how to lead a team of interdisciplinary health professionals to provide optimal care to patients."

What it means to you While an ACO may sound like another alphabet-soup health management program--like an HMO or PPO--Dr. Farber notes that the key differences are that ACOs are led by providers, not insurance companies, and that ACOs take a proactive approach to care coordination. The goals are to eliminate needless duplication of services, reduce medical errors, and help avoid the confusion that confronts many patients as they try to manage multiple health conditions.

"Patients will benefit from care coordinators who work in their doctor's practice and can assist them in navigating the often complex health care system," Dr. Farber confirms. For example, a 55-year-old woman who has not undergone a recent screening mammogram will likely get a call from an ACO care coordinator and get the exam scheduled, as opposed to waiting until the next office visit, where it may or may not come up in the conversation.

Working with your doctors Unlike most health insurance plans, patients do not sign up to participate in an ACO. Their doctors do, and patients may become unaligned with the ACO simply by deciding to receive care elsewhere. "There is no restriction on their health care utilization or closed network of participating providers," Dr. Farber says. Fee-for-service Medicare patients who see providers in an ACO maintain all their Medicare rights, including the right to choose any doctors and providers that accept Medicare. If one of your doctors is in an ACO but another is not, you can still see both physicians without any complications.

The expectation is that ACOs will improve health care for older adults, and that this will result in Medicare savings because better care that avoids duplication and errors usually costs less. However, because ACOs are new, many doctors are still learning about how they work and what changes they will bring. It's likely that more doctors will be participating in ACOs in the next few years. "It must get confusing for some patients," Dr. Farber says. "Medicare has very good information available for patients both on its website (www.medicare.gov) and at 1-800-Medicare."

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Publication:Focus on Healthy Aging
Geographic Code:1USA
Date:Aug 1, 2013
Words:516
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