Are Accountable Care Organizations (ACOs) only for Medicare beneficiaries?

At the present time, Medicare funds are supporting ACO formation around the country to serve Medicare beneficiaries.  In January 2013, CMS announced 106 new organizations will be participating in the Medicare-sponsored ACO programs, taking the participation numbers to over 250 nationwide.

Additionally, some states are looking at the ACO to service Medicaid patients in their attempt to improve quality and reduce costs.

Some commercial insurers are supporting ACO development for their own members as well.

Innovative physician-led organized groups have been following the ACO care model with all of their patients for decades and are participating in both Medicare and commercial ACO pilot programs.  

The intention of the Affordable Care Act is that ACOs will eventually be available to everyone.  Multispecialty medical groups, physician-hospital organizations (PHOs), integrated delivery systems (IDSs), and independent practice associations (IPAs) are likely candidates to become the ACOs of the future.

ACO Programs at CMS

Medicare offers several ACO programs, including:

• Medicare Shared Savings Program (cms.gov) - For fee-for-service beneficiaries
• Advance Payment ACO Model - For certain eligible providers already in or interested in the Medicare Shared Savings Program
• Pioneer ACO Model - Health care organizations and providers already experienced in coordinating care for patients across care settings
• ACO: Accelerated Development Learning Sessions - For existing or emerging Accountable Care Organizations (ACOs) to develop a broad and deep understanding of how to establish and implement core functions to improve care delivery and population health while reducing growth in costs.

General information on ACOs can also be found at cms.gov/aco and this HealthCare.gov ACO Fact Sheet.