<h1>ACO Overview</h1>
<p class="intro">While accountable care organizations may sound like a newly constructed system for care coordination and cost control, the emphasis on quality reporting and data exchange is not.</p>
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<h2>What is an ACO?</h2>
<p>An accountable care organization is a group of healthcare providers who work collaboratively to deliver coordinated care and chronic disease management, thus improving the quality of care patients receive.</p>
<p>The organization's payment is tied to achieving healthcare quality goals and outcomes that result in cost savings. Medicare ACOs were formed by the Patient Protection and Affordable Care Act of 2010 (PPACA), with Medicaid and commercial ACOs following suit.</p>
<p>Specific goals of the accountable care initiative include:</p>
<ul>
<li>Harness growing healthcare costs annually approaching $3 trillion</li>
<li>Advance EHR-driven preventive medicine, care coordination and wellness focusing on each patient’s care continuum under a patient-centered medical home (PCMH) concept</li>
<li>The ability to collect and analyze clinical, claims and payer data to enable quality monitoring and reporting</li>
<li>Promote remote monitoring/telehealth to advance the communication of care plans to patients</li>
</ul>
<p>Improving patient outcomes through care plans coordinated within a physician practice, hospital and related healthcare settings is an achievable goal through quality electronic health record systems impacting clinical, financial and administrative ends.</p>
<p>Through Greenway's integrated EHR, practice management and interoperability solution <a href="/solutions/prime-suite/" target="_self">PrimeSUITE^®</a>, ACOs can experience the robust integration, usability and point-of-care workflows necessary to deliver evidence-based, long-term, coordinated care. Related Greenway solutions provide additional value to PrimeSUITE users in the ACO setting, including our integrated data exchange engine, <a href="/solutions/prime-exchange/" target="_self">PrimeEXCHANGE™</a>; the connectivity platform <a href="/solutions/prime-datacloud/" target="_self">PrimeDATACLOUD™</a>; the <a href="/solutions/prime-patient/" target="_self">PrimePATIENT^®</a> online portal; and our remote clinic solution, <a href="/solutions/prime-mobile/" target="_self">PrimeMOBILE™</a>.</p>
<h2>Eligible ACO membership</h2>
<p>The Shared Savings Final Rule offers flexible start dates for Medicare ACO entities, either April 1 or July 1 of 2012, or Jan. 1, 2013. As defined in the final rule, participation within a Medicare ACO requires maintaining a 5,000-patient minimum, with providers allowed to join more than one entity. Membership is available to a wide range of care providers in an effort to coordinate care among various settings. Medicaid ACOs follow a similar structure.</p>
<p>Commercial ACO arrangements are not subject to PPACA regulations and continue to form around the country. Such models involve payers, hospitals and physician groups, while others involve only one of the latter two; some health insurers are also beginning to implement payment systems that reward quality care outcomes.</p>
<p>An ACO may be comprised of the following member structure:</p>
<ul>
<li>Primary care physicians, specialists, nurse practitioners and clinical nurse specialists in group practice arrangement</li>
<li>Networks of individual practices of ACO professionals</li>
<li>Joint venture between hospitals, providers, and commercial payer organizations</li>
<li>Hospitals employing ACO providers</li>
<li>FQHC, CHC rural health clinic (RHC) facilities, eligible critical-access hospitals, and home health networks</li>
<li>Other Medicare providers and suppliers as determined by the Secretary of the U.S. Dept. of Health and Human Services (HHS)</li>
</ul>
<p>Shared Savings models have been compared to former HMO models, but there are a few instances in which they differ. Providers, not payers will be responsible for quality care and accountability. Also, the accountable care organizations are structured to contract with provider organizations, not health plans. There is a more-flexible system of care models available in an ACO, including the fact that health plans are allowed as an entity within an ACO. Overall, the most major difference is the utilization of health IT as the foundation.</p>
<h2>ACO quality measures</h2>
<p>For Medicare ACOs, the Centers for Medicare &amp; Medicaid Services (CMS) has currently developed 33 quality measures for members of the organization to report against to determine if the entity qualifies to share in the savings.</p>
<p>There are four reporting domains, and the entity must achieve at least 70% within each of the four to meet benchmarks:</p>
<ol>
<li>Patient/Caregiver Experience (7 measures)</li>
<li>Care Coordination/Patient Safety (6 measures)</li>
<li>Preventive Health (8 measures)</li>
<li>At-Risk Population (12 measures)</li>
</ol>
<p>Commercial ACOs have begun to enter into similar risk-sharing payment models; however, quality measures may vary significantly between various private payers. Organizations that meet agreed-upon performance levels on a range of specific quality measures are rewarded financially and are penalized for exceeding spending targets.</p>