My medical practice will soon join an accountable care organization, or ACO. I’ll then be part of a group of doctors, hospitals, and other health care providers who have come together to offer “high-value care.” That means bringing higher-quality medical care to patients and lowering costs by reducing the use of unnecessary tests and treatment. I’m signing on because it will give me access to a larger team of physicians and other experts to help me manage patients.

You might already be one of the roughly 24 million Americans (including 6 million Medicare users) who are being served by an ACO. If not, physician participation is increasing, so you are likely to get a letter in the near future from one or more of your health care providers informing you of his or her participation in an ACO.
 

ACOs and Your Medical Care

The ACO that I am joining is a Medicare ACO, which means all of the providers accept Medicare’s traditional insurance. (Some others accept private insurance.) The Department of Health and Human Services is encouraging more Medicare health care providers to consider models like ACOs, in part to curtail runaway medical care expenses—which are leading to higher Medicare premiums for some consumers.

How? Under the traditional fee-for-service payment system, health care providers are compensated for each office visit, test, and procedure—the greater the volume, the more we are paid.

An ACO is financially rewarded for keeping patients healthy and driving down the number of tests, procedures, and doctors’ visits that have no clear benefit to the patient. A key part of that is ensuring that providers communicate more closely and help their patients—especially those who have chronic illnesses such as high blood pressure or heart disease—select the right treatments and skip those that are unneeded.
 

How an ACO May Change Your Office Visits

If your doctor joins an ACO, your office visits may start to have more emphasis on preventive services and strategies for staying well. If you have a chronic condition such as diabetes, for instance, you and your doctor may spend more time discussing ideas for stabilizing your blood sugar. You may also find that you have a larger health care team.

An ACO won’t reduce your time with your doctor, but he or she may assign a high-level nurse to help you manage your diabetes or other complex illness. Or an ACO’s pharmacist may contact you to discuss your medications. You will also be given the choice of whether you want your health data to be shared within the ACO. That allows the doctors to study your information—along with data from many other patients—to determine how to provide the best care for all.

Get the Best Medical Care With an ACO

  • Decide whether you want to stay with your current provider (when providers join an ACO, they are required to inform patients). You can seek another physician if you don’t want to participate in an ACO—if, for example, you’re concerned that it may restrict access to specialists or tests.
  • Ask your provider to clearly explain what changes in your medical care you may expect to see as a result of her participation in an ACO. Find out what extras, such as wellness programs or opportunities to work with nurses and other health care professionals, you may have through the ACO.
    Going forward, pay close attention to referrals you receive to other health care professionals. Your doctor will probably refer you only to hospitals and specialists within the ACO network. If you have other preferences, ask your provider whether he will help you see a doctor of your choice.
  • If you believe that you need a medical test or procedure and your doctor declines, that may be a reflection of the ACO’s cost-saving efforts. But it’s more likely to be a reflection of better medical care. If you’re uncertain, ask your doctor why the test or procedure should not be done and which medical guidelines he or she is following.