Information for Physicians
An Accountable Care Organization (ACO) refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in Medicare Fee-For-Service Beneficiary’s care) that work together to coordinate care for the Medicare Fee-for-Service Beneficiaries they serve. The goal of an ACO is to deliver seamless, high-quality care for Medicare beneficiaries, instead of the fragmented care that often results from a Fee-For-Service payment system in which different providers receive different, disconnected payments.
Chicago Health System ACO, LLC., is a Medicare fee-for-service beneficiary-centered organization in which the Medicare fee-for-service beneficiary and providers are true partners in care decisions. ACOs create incentives for health care providers to work together to treat an individual Medicare Fee-For-Service Beneficiary across care settings – including doctors’ offices, hospitals, and with post-acute care services. The Medicare Shared Savings Program (Shared Savings Program) rewards ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting Medicare Fee-For-Service Beneficiaries first. Provider participation in an ACO is purely voluntary.
How Do ACOs Help Physicians Coordinate Care?
Health care providers have reported that a barrier to improving care coordination is lack of information. While they may know about the services they provide to the beneficiary, they don’t know about all other services provided to the beneficiary. To better treat Medicare fee-for-service beneficiaries and to coordinate their care, ACOs will receive Medicare health information about their Medicare fee-for-service beneficiaries from CMS, regardless of their location of care. Before doing so, ACOs must notify a beneficiary in writing that it will request the beneficiary’s health information from CMS. ACOs must allow beneficiaries to decline having their health information shared with the ACO.
Declining to have this information shared, however, does not affect the provider’s participation in the ACO, the care that is delivered by the provider to their Medicare Fee-For-Service Beneficiaries or CMS’ use of the beneficiaries data for the purpose of assessing ACO’s performance on quality or cost measures (the ACO will not receive the data).
How Does Shared Savings Work?
Medicare will continue to pay individual providers and suppliers for services as it currently does under the Medicare Fee-For-Service payment systems. Chicago Health System ACO, LLC., is participating in the two-sided risk model, in which the ACO shares in both savings and losses. If the ACO saves money, the ACO and its physicians will be able to share in the savings. If the ACO exceeds the budget, Chicago Health System ACO, LLC., will pay back the over runs to CMS, and participating physicians will assume no downside risk.
How Can Physicians Participate In Chicago Health System ACO, LLC.?
Physicians who are interested in participating in the Medicare Shared Savings Program with Chicago Health System ACO, LLC., should contact the ACO at 708-783-7100.