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How to Become An Accountable Care Organization

How and Why Do I Become An ACO?

ACOs are an attempt to shift financial rewards for quantity of care to providing the highest quality of care.  ACOs (Accountable Care Organizations) focus not on sick care, but on preventative, efficient, and targeted primary care.

Many people argue that ACO's are no different than the managed care programs that were available in the 1990's. Those programs attempted to reign in costs by using cost-sharing incentives, and rewarded physicians that used less costly forms of care. Regardless, ACOs do not seem poised to vanish like other variations of this approach.

The number of hospitals and care facilities that have become part of ACO networks has increased significantly over the years. And with the Affordable Care Act rewarding ACO models, there are many newcomers who are wondering 'How do I become an ACO?' and 'How are ACO's paid?'

First of all, you need to be sure you understand how ACOs work, and how your facility, role, and financial projections will be impacted compared to your current professional activity. You will also want to do your homework to find out what other offices and hospitals will be in your network.

You may want to meet with some of them and learn about their experiences and success thus far. You may also start discussing ways you would work together.  

One of the first things you will want to do is build your IT capabilities before moving ahead. Don't put the cart before the horse and rush to become an ACO until you have the proper IT network in place. Since you will be working with other offices, you will transfer information out of your office network more often. You might even use third-party software and portals to manage information, including private patient information.

There is also a financial risk involved with poor tech management. Several reports have concluded that poor patient data communication can cost the industry billions every year. 

Outline your clinical strategies for communicating among offices and with patients to avoid unnecessary risks and readmissions. Be sure your staff understands how their role may need to change, and make sure they are proficient in any new technology they may need to use. Your informatics team will also need to understand the security risks involved in working with new software and outside networks. You may even want to consider making an 'ACO for Dummies' type of educational program to help your employees understand the basics of this organizational shift.

Types of organizations that can become ACO's:

  • Group practices that include primary care physicians
  • Community and primary care hospitals that perform most inpatient services
  • Tertiary care centers
  • Academic hospitals
  • Inpatient and outpatient mental health
  • Rehabilitation centers

All facilities will also be expected to meet these requirements to form an ACO: 

  • Handle a minimum number of 5,000 Medicare patients per year
  • Have a organizational structure with clinical and administrative effectiveness
  • Evidence-based medicine and coordination or care, including reporting on the data tied to performance and cost
  • Minimum three year commitment 

While this is a basic introduction to becomeing an ACO, if you want to learn about ACO accreditation, you can learn more at the NCQA website. The NCQA (National Committee for Quality Assurance) has a mission to help healthcare facilities prove they can be more efficient and improve quality of care. They handle auditing and reporting back to you areas of improvement.

Contacting them is your first serious step in learning how to become an Accountable Care Organization.