What is Healthier Communities ACO?
Healthier Communities ACO is a newly formed network of physicians and other health care providers collaborating under common governance to bring high quality, coordinated care at a reduced rate of cost to Medicare Fee-for – Service patients. Initiated as of January 2020, Healthier Communities ACO will be approved by the Centers for Medicare and Medicaid Services (CMS). Healthier Communities ACO has signed a five year renewable agreement with CMS to serve its Medicare Fee-for –Service beneficiaries whose providers participate in Healthier Communities ACO at a reduced rate of cost.
What is the purpose of Healthier Communities ACO?
Recent healthcare reforms are changing the old way of doing business by introducing new requirements and incentives to improve quality and efficiency. In response, physicians, hospitals and other health care providers must adapt and raise the level of performance. Healthier Communities ACO is a collaborative effort that will help all participating providers meet these new quality and efficiency standards and take advantage of the resulting incentives.
Who may participate in Healthier Communities ACO?
All physicians who are committed to providing quality, appropriate and efficient care to Medicare Fee-for –Service beneficiaries while reducing costs are encouraged to apply to participate in Healthier Communities ACO. Critical access hospitals, rural health centers and federally qualified health centers are also encouraged to collaborate with Healthier Communities ACO and share in the savings. Healthier Communities ACO members will work together to ensure all providers meet performance standards on quality of care and help Medicare Fee-for Service patients navigate the health system.
Quick Resources
ACO Beneficiary Fact Sheet — Accountable Care Organizations and YOU
For additional information about the ACO, please visit www.medicare.gov/acos.html or call 1-800-MEDICARE and tell the operator you are asking about ACO's.
Listen to a conversation with the CEO about what it’s like to run a hospital on WTBQ Radio’s weekly talk show, “Health Matters.” Mary Leahy, MD, MHA, CEO, and Michele Muldoon, NP, Chief Clinical Officer of Bon Secours Charity Health System, a member of the Westchester Medical Center Health Network, offer a behind-the-scenes glimpse into how we ensure quality patient care and great experiences for our patients and their loved ones.
Bon Secours Healthier Communities ACO, LLC, is a newly created Accountable Care Organization (ACO) that received approval from the Centers for Medicare and Medicaid Services (CMS) to participate in the Medicare Shared Savings Program (MSSP), effective January 1, 2020. Part of the Affordable Care Act of 2010, the MSSP is intended to facilitate cooperation among health care providers for the coordination of care for Medicare Fee-for-Service beneficiaries. The goal of coordinated care is to ensure the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. Healthier Communities ACO is designed to allow participating providers to provide appropriate coordinated care at a time when it is needed and in a setting that is both convenient and appropriate.
Participating health care providers in Healthier Communities have committed to work together voluntarily to provide Medicare Fee-for-Service beneficiaries with the following advantages:
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Coordinated Care - The doctors and other providers who are caring for you communicate with each other and partner with you in making health care decisions. Your doctors use data from Medicare, such as your medical history and prescriptions, to help improve how they provide your care.*
- Efficient Care - You may spend less time filling out medical paperwork because your doctors may already have this information in a confidential electronic health record. You will be able to avoid duplicative medical tests because your doctors and hospitals will share information and coordinate your care.*
- Cost-Effective Care - Your care providers are reimbursed, in part, based on providing improved care, improved coordination, and improved value - not just more tests and procedures.*
- Patient-Focused Care - You are the center of care. Your doctors can listen to you, honor your choices, and keep you better informed.*
*source medicare.gov
If you have ACO questions, please call 1-800 MEDICARE.
An ACO:
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Promotes seamless coordinated care
- Puts the beneficiary and family at the center
- Remembers patients over time and place
- Attends carefully to care transitions
- Coordinates resources carefully and respectfully
- Proactively coordinates the Medicare Fee-for-Service beneficiaries’ care
- Evaluates data to improve care and patient outcomes
- Innovation around improved health, improved care and lower growth in costs
- Invests in team-based care and workforce
Key Terms
ACO (Accountable Care Organization)
A collection of health care providers and care coordination professionals working together to coordinate care for a defined population. The goal is to reduce overall costs and improve quality and outcomes. CMS adopted the ACO model as a way to increase care coordination, reduce unnecessary medical care, improve health outcomes, prevent medical errors, and decrease utilization of health care services for its Medicare Fee-for-Service beneficiaries who are enrolled in the traditional fee-for-service program assigned to the ACO. If the ACO is successful, participants receive a percentage of shared savings or bonus payments based on savings benchmarks and quality measures.
ACO Participant
An individual or a group of ACO providers/suppliers identified by a Medicare–enrolled tax identification number (TIN) that alone or together with one or more other ACO participants comprises the ACO. An ACO participant may be a solo practice, group practice, acute-care hospital, federally qualified health center (FQHC) critical access hospital, rural health center, pharmacy, and other entities that are Medicare-enrolled.
ACO Provider/Supplier
A provider or supplier enrolled in Medicare that bills for items and services furnished to Medicare Fee-for-Service beneficiaries under a Medicare billing number assigned to the TIN of an ACO participant. (A large group practice may qualify as an ACO participant. A Medicare-enrolled physician who is billing under the practice’s TIN would be an ACO provider/supplier.)
Medicare Shared Savings Program (MSSP)
CMS has created financial incentives for ACO health care providers to work together when treating individual Medicare Fee-for-Service patients across care settings. ACO providers share—with Medicare—and savings generated from lowering health care costs while meeting standards for quality of care and providing Medicare Fee-for-Service patient-centered care. (Healthier Communities ACO will participate in the Basic Track glide path of the MSSP. This model is designed for less experienced.
ACO Components: High Level Summary
Governance and Organizational/Legal
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Legal entity with a Board representing ACO participants and Medicare Fee-for-Service beneficiaries
- Organizational considerations including: Stark, Anti-Kickback, Antitrust, and Tax
Care Coordination
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Evidence-based medicine: adoption and use of protocols
- Care coordination, care transitions and access to services and providers typically supported by nurse care managers, navigators, etc.
- Coordination with home and community-based services
Health Information Technology (IT)
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Population-based clinical intelligence, decision support, registries, EHR
- Care coordination, communication, and workflow technology
- Secure clinical data exchange
- Mobile consumer applications and personal health records
Analytics and Reporting
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Consume, process, and analyze administrative and clinical data
- Identify trends in utilization, prevalence of disease, “hotspots”
- MSSP quality measures focused primarily on care delivered in the ambulatory setting (NQP, PQRS)
Patient Engagement
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Activating Medicare Fee-for-Service patients and providing culturally appropriate care and improving the Medicare Fee-for-Service patient experience
- Patient self-coordination and shared decision-making
The Affordable Care Act...
Refers to the Patient Protection and Affordable Care Act of 2010, which came about to help physicians, hospitals, and other caregivers improve the safety and quality of patient care while making health care more affordable. The intent of the act is to create a reformed health care delivery system that makes health care providers accountable for both the care and cost of care they deliver to Medicare Fee-for-Service patients. The act focuses on the needs of patients while linking payments to outcomes with the goal of improved health and communities and slow cost growth.
On March 31, 2011…
The Department of Health and Human Services (HHS) released proposed new rules to help doctors, hospitals, and other providers better coordinate care for Medicare Fee-for-Service patients through Accountable Care Organizations (ACOs). ACOs create incentives for health care providers to work together to treat an individual Medicare Fee-for-Service patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting Medicare Fee-for-Service patients first. Provider participation in an ACO is purely voluntary.
Bon Secours Medical Group…
Established an Accountable Care Organization (Healthier Communities ACO) as the culmination of its journey toward clinical transformation and care coordination. Healthier Communities ACO is a partnership arrangement between ACO professionals (including primary care physicians) that is, effective January 1, 2020, accountable for the quality, cost, and overall care of 10,000 Medicare Fee-for-Service beneficiaries assigned to it by the Center for Medicare and Medicaid Services.
Healthier Communities ACO…
Has in place a leadership and coordination structure that includes clinical and administrative systems developed within Bon Secours Health System over the past decade. As a result, the ACO is supported by a system wide electronic health record, health information exchange, palliative care leadership, care coordination functions, community outreach professionals, and patient-centered medical home infrastructures within its primary care networks.
ACO PUBLIC REPORTING
Healthier Communities ACO Key Leadership Personnel
Organizational Chart