Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. Show
ACO Programs at CMSMedicare offers several ACO programs, including:
Case Studies
Toolkits
Tip Sheet
A series of three Accelerated Development Learning Sessions were held in select cities across the country. Additional information on each Session can be accessed below:
General information on ACOs can also be found at cms.gov/aco and this hhs.gov ACO Fact Sheet. What is an ACO?An Accountable Care Organization (ACO) is a group of doctors and other healthcare providers who agree to work together with Medicare to give you the best possible care. ACOs may take different approaches to giving you coordinated care. Some ACOs may have special nurses that help you set up appointments or make sure your medications are in order when you enter or leave a hospital. Other ACOs may help your doctors get you equipment for monitoring your medical conditions better at home, if you need it. Most ACOs use advanced systems that let them more carefully track your care, and make sure your doctor has the most up-to-date information about your health. The goal of the ACO is to support your doctor in caring for you. ACOs help your doctor and healthcare providers work together more closely, by making sure they have the most up-to-date information about your health and your care. For you, this
means your doctors communicate better with each other, and you avoid having duplicate tests or answering the same questions over and over. Working together, your doctors can do more to follow your health, make sure you get the best possible care, and may hire additional staff to help meet your unique care needs, depending on what works best for you. Doctors and other healthcare providers choose to participate in an ACO because they’re committed to your care experience. They may also be rewarded for offering you better, more coordinated care. If your physician is part of the Indiana University Health ACO, you will be notified, either in person or by letter. An ACO isn’t the same as a Medicare Advantage Plan or Health Maintenance Organization (HMO). You’re still in Original Medicare, and your Medicare benefits, services, rights and protections won’t change. And you still have the right to use any doctor or hospital that accepts Medicare at any time, the same way you do now. Additionally, patients can receive acute care treatment at urgent care facilities aligned with Indiana University Health ACO, Inc. Search for an IU Health Urgent Care location close to you. The Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients. The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries. Included in the Next Generation ACO Model are strong patient protections to ensure that patients have access to and receive high-quality care. Like other Medicare ACO initiatives, this Model will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures. This is in accordance with the Department of Health and Human Services’ “Better, Smarter, Healthier” approach to improving our nation’s health care and setting clear, measurable goals and a timeline to move the Medicare program―and the health care system at large―toward paying providers based on the quality rather than the quantity of care they provide to patients. In addition, CMS will publicly report the performance of the Next Generation Pioneer ACOs on quality metrics, including patient experience ratings, on its website. Next Generation Accountable Care Organization Model DetailsThe Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients. The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries. Included in the Next Generation ACO Model are strong patient protections to ensure that patients have access to and receive high-quality care. Like other Medicare ACO initiatives, this Model will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures. This is in accordance with the Department of Health and Human Services’ “Better, Smarter, Healthier” approach to improving our nation’s health care and setting clear, measurable goals and a timeline to move the Medicare program―and the health care system at large―toward paying providers based on the quality rather than the quantity of care they provide to patients. In addition, CMS will publicly report the performance of the Next Generation Pioneer ACOs on quality metrics, including patient experience ratings, on its website. Indiana University Health ACO, Inc.IU Health ACO: 317.963.5522 or . Centers for Medicare and Medicaid Services (CMS): 800.633.4227 (TTY 877.486.2048) Indiana University Health ACO, Inc., Hours: Monday-Friday, 8am-5pm Primary Contact: Tori Bratcher, Executive Director of ACO & Population Health Operations Organizational InformationIndiana University Health ACO, Inc.’s Participant Entities
Indiana University Health ACO, Inc.’s Governing Body
Key Clinical and Administrative Leadership (all employed by Indiana University Health, Inc.)
Types of ACO participants, or combination of participants, that formed the ACO
Indiana University Health ACO, Inc.'s ParticipantsIndiana University Health ACO, Inc.’s Preferred ProvidersPublic ReportingInformation Related to Indiana University Health ACO, Inc.’s Qualification for Next Generation ACO Model Pre-Participation and Participation WaiversThe Indiana University Health ACO is eligible to use the 3-Day Skilled Nursing Facility Waiver, Telehealth Waiver, and Cost Sharing Support for Part B Services Waiver. The Board of Directors for Indiana University Health ACO, Inc. (“IU Health ACO”) has approved execution of a Memorandum of Understanding Regarding Contribution of Support Services by and among IU Health ACO and Indiana University Health, Inc. (“IU Health”) and Indiana University Health Care Associates, Inc. d/b/a IU Health Physicians (“IU Health Physicians”). In order to assist IU Health ACO in its pursuit of the Next Generation ACO Model’s three-part aim of (1) better care for individuals, (2) better health for populations, and (3) lower growth in Medicare Parts A and B expenditures, IU Health and IU Health Physicians have agreed to provide certain support services to IU Health ACO for startup and ongoing operations of IU Health ACO. The support services include:
Indiana University Health ACO, Inc. (“IUHACO”) is currently participating in the Next Generation ACO Model (“NGACO”) pursuant to a Participation Agreement with the Centers for Medicare & Medicaid Services (“CMS”) initially entered into effective January 1, 2017, and renewed effective January 1, 2019 for a successive two-year term. The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain fraud and abuse laws that otherwise limit innovation by Accountable Care Organizations (“ACO Waivers”). The ACO Waivers provide for a waiver of federal fraud and abuse laws for arrangements entered into by an NGACO that are reasonably related to the purposes of the NGACO (the “NGACO Participation Waiver”). In order to receive the benefit and protection of the NGACO Participation Waiver, the Board of Directors of IUHACO, after discussion and deliberation, has made a bona fide determination that the following Arrangement (“Arrangement”) is reasonably related to the purpose of the IUHACO NGACO, and is publicly disclosing the Arrangement in accordance with the requirements of the NGACO Participation Waiver. IUHACO has worked with Indiana University Health Physicians to develop IU Health Connected Care Clinics at IU Health Saxony Hospital and in Indianapolis. The Connected Care Clinic is an alternative care model that allows healthcare and other providers to focus on IUHACO NGACO beneficiaries and other value based care members. The Connected Care Clinic is a move away from a volume based care model to a care model based on providing additional care management resources to support the reduction of the cost of health care through better coordination of care, more robust chronic disease management and improved quality of care. The Board of Directors of IUHACO has made a bona fide determination that the Connected Care Clinics are reasonably related to and meets the purposes of the NGACO by providing resources to provide better care for individuals, better health outcomes, reducing the cost of healthcare and improving the work life balance of healthcare providers and staff. Future arrangements, and modifications to current arrangements, will be disclosed in accordance with CMS requirements. The Indiana University Health ACO does not have any joint ventures with Next Generation ACO Participant Providers or Preferred Providers to disclose. Waiver DisclosuresInformation Related to Indiana University Health ACO, Inc.’s Qualification for Next Generation ACO Model Pre-Participation and Participation WaiversThe Indiana University Health ACO is eligible to use the 3-Day Skilled Nursing Facility Waiver, Telehealth Waiver, and Cost Sharing Support for Part B Services Waiver. The Board of Directors for Indiana University Health ACO, Inc. (“IU Health ACO”) has approved execution of a Memorandum of Understanding Regarding Contribution of Support Services by and among IU Health ACO and Indiana University Health, Inc. (“IU Health”) and Indiana University Health Care Associates, Inc. d/b/a IU Health Physicians (“IU Health Physicians”). In order to assist IU Health ACO in its pursuit of the Next Generation ACO Model’s three-part aim of (1) better care for individuals, (2) better health for populations, and (3) lower growth in Medicare Parts A and B expenditures, IU Health and IU Health Physicians have agreed to provide certain support services to IU Health ACO for startup and ongoing operations of IU Health ACO. The support services include:
Indiana University Health ACO, Inc. (“IUHACO”) is currently participating in the Next Generation ACO Model (“NGACO”) pursuant to a Participation Agreement with the Centers for Medicare & Medicaid Services (“CMS”) initially entered into effective January 1, 2017, and renewed effective January 1, 2019 for a successive two-year term. The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain fraud and abuse laws that otherwise limit innovation by Accountable Care Organizations (“ACO Waivers”). The ACO Waivers provide for a waiver of federal fraud and abuse laws for arrangements entered into by an NGACO that are reasonably related to the purposes of the NGACO (the “NGACO Participation Waiver”). In order to receive the benefit and protection of the NGACO Participation Waiver, the Board of Directors of IUHACO, after discussion and deliberation, has made a bona fide determination that the following Arrangement (“Arrangement”) is reasonably related to the purpose of the IUHACO NGACO, and is publicly disclosing the Arrangement in accordance with the requirements of the NGACO Participation Waiver. IUHACO has worked with Indiana University Health Physicians to develop IU Health Connected Care Clinics at IU Health Saxony Hospital and in Indianapolis. The Connected Care Clinic is an alternative care model that allows healthcare and other providers to focus on IUHACO NGACO beneficiaries and other value based care members. The Connected Care Clinic is a move away from a volume based care model to a care model based on providing additional care management resources to support the reduction of the cost of health care through better coordination of care, more robust chronic disease management and improved quality of care. The Board of Directors of IUHACO has made a bona fide determination that the Connected Care Clinics are reasonably related to and meets the purposes of the NGACO by providing resources to provide better care for individuals, better health outcomes, reducing the cost of healthcare and improving the work life balance of healthcare providers and staff. Future arrangements, and modifications to current arrangements, will be disclosed in accordance with CMS requirements. The Indiana University Health ACO does not have any joint ventures with Next Generation ACO Participant Providers or Preferred Providers to disclose. What is an accountable health plan in Arizona?1. "Accountable health plan" means an entity that offers, issues or otherwise provides a health benefits plan and that is approved by the director as an accountable health plan pursuant to section 20-2303.
What is considered the purpose of the Wisconsin Insurance Security Fund quizlet?The Insurance Security Fund was created to provide insureds with protection against an insurer's liquidation. The Fund's money is generated by assessments against all insurers licensed to do business in Wisconsin, with limited exceptions.
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In order for a health plan to be an accountable health plan who has to approve it
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