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 improve your 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 doctors get you equipment for monitoring your medical conditions at home, if you need it. Most ACOs use advanced systems that let them more carefully coordinate 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 by making sure your doctor has the most up-to-date information about your health and your care. For you, this means your doctor communicates more effectively with your other doctors, and you avoid having duplicate tests or answering the same questions over and over. Reducing duplicate work may help save you money as well. Working together, we can do more to follow your health, make sure you get the care you need, and may hire additional staff to help meet your unique care needs, depending on what works for you.
Doctors and other healthcare providers choose to participate in an ACO because they are committed to providing you with a quality care experience. They may also be financially rewarded for offering you improved, more coordinated care.
An ACO isn’t 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.
Do I have to participate in an ACO because my doctor participates?
No. Only your doctor participates in an ACO. As the patient, you do not participate in the ACO. You still have the right to see any doctor or hospital that accepts Medicare. You can continue to get care from your doctor, or you can choose to see a doctor who does not participate in an ACO.
Can I still see all of my regular Medicare doctors and healthcare providers even though my doctor participates in an ACO?
Yes, that doesn’t change. Always keep in mind that:
- You can still go to any doctor, hospital, or other provider that accepts Medicare. Nobody can restrict which providers you see.
- You’re still in Original Medicare.
- You’re still entitled to all the same Medicare services, benefits, and protections.
What information about me will the ACO have access to?
To help doctors who participate in an ACO give patients like you quality and coordinated care, Medicare wants to share some additional information about your care with the ACO. This information includes things like doctor, hospital, and pharmacy visits in the past and moving forward. Your health care information helps the ACO track the services you’ve already gotten, understand where you may need more care, and find ways to smooth the path for you if you have to transfer in or out of a hospital, or from the care of one doctor to another.
If you do not want Medicare to share your health care information with the ACO, you can call 1-800 MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Tell the operator you’re calling about ACOs and you don’t want to share your health care information with an ACO.
If you have opted out of sharing your health information with WKCC in the past, but would like to change your preferences so WKCC can provide you with improved care, you can call 1-800-MEDICARE. Tell the operator you’re calling about ACOs and you want to change your data sharing preferences.
What if I am already happy with my care the way it is?
We are glad you’re having a positive experience already. Even though your doctor is participating in an ACO, you’ll continue to see your doctor the way you have been. Your doctor’s participation in an ACO doesn’t change your benefits in any way, and decisions about your care stay between you and your doctor.
How will being in an ACO help my doctor?
Doctors in ACOs may have greater access to the expertise, staff, and technologies we need to make sure your care is coordinated across all the places you get services. For you, this coordination could mean less paperwork to fill out at the doctor’s office, avoiding unnecessary tests, or more help for you in dealing with any health conditions.