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ACOs & Patients: Care Focused on Individuals 

Accountable care organizations (ACOs) are designed to help patients by focusing on proactive, whole-person care. The traditional U.S. health care system is complicated, difficult to navigate, and not set up to keep patients healthy. Many struggle to find the right doctor and get good quality care at the right time and setting. ACOs do things differently by rewarding providers for coordinating patients’ care and improving health outcomes.  

ACOS HELP PATIENTS & OFFER BETTER QUALITY CARE 

ACOs focus on keeping patients healthy, rather than waiting until they get sick to get care. ACOs enable health care providers to work as a team to coordinate care and better manage chronic conditions, leading to healthier lives and less money spent on health care. ACO care teams can include physicians, nurses, care coordinators, social workers, behavioral health specialists, community health workers, physical therapists, and more — all working together to help patients achieve their health care goals. ACOs support patients and their families and caregivers by coordinating follow-up care and ensuring care plans meet their needs and preferences. 

•  Evaluations have consistently shown that ACOs are improving outcomes and care experiences for their patients.
• A study of Medicare ACOs’ quality found they outperform non-ACO providers on 81 percent of quality measures.

ACOS HELP LOWER COSTS & PROVIDE EXTRA BENEFITS TO PATIENTS

ACOs aim to lower costs by avoiding unnecessary services or duplicate tests, helping patients find affordable treatment options (like lower cost prescriptions, telehealth appointments, or connections to assistance programs), and keeping patients healthy so they can spend less money on health care. Getting care in an ACO doesn’t raise your premiums, deductibles, or other out of pocket costs. If you have Traditional Medicare, ACOs are part of your Medicare benefit. Patients continue to get all the same health benefits if they are part of an ACO, and depending on the ACO, patients may also receive extra benefits for free such as:

• personalized care coordination,
• chronic disease management rewards,
• transportation to appointments,
• care in more convenient settings like at home or through telehealth,
• extra support through care transitions,
• reduced or no out-of-pocket payments for some services, and more!

ACOS SUPPORT PATIENT-CENTEREDNESS & PATIENT CHOICE

ACOs focus on patient-centered care. ACOs do not limit patients’ choice of providers or require additional steps to access care. Primary care clinicians in an ACO may recommend other ACO providers to help coordinate patients’ care, but patients can still choose to see any provider that accepts their insurance. Depending on their health insurance plan, patients may have the option to sign up for an ACO, or if a patient chooses to receive most of their care from providers in an ACO, that patient will be part of the ACO.

ACOS ARE IMPROVING PEOPLE’S LIVES

The stories below are about real patients (some names changed for privacy) receiving care from ACOs. When health care focuses on treating the whole person and holding providers accountable for quality of care along with costs, the experience of health care and patient outcomes improve.

ACOs listen to patients’ personal health goals and support patients with multiple conditions by coordinating with different providers and creating care plans that support those goals.
Real Story: 90-year-old Carson was overwhelmed with navigating the health care system and managing his multiple conditions, which included congestive heart failure, stage four chronic kidney disease, hypertension, obstructive sleep apnea, and osteoarthritis. “I was getting loaded up with disease problems and doctor visits. And it was just absolutely overwhelming,” he said. Luckily, Carson’s physician was part of an ACO that assigned a care manager, Heather, to help him. Heather and Carson discussed his health goals, with his main goal being to avoid dialysis. To prevent his kidney disease from progressing, Heather educated Carson on the importance of checking his blood pressure and weight daily to monitor the potential buildup of excess fluids. Heather also discovered Carson was having bloodwork taken more often than necessary, and she coordinated with his specialists to avoid repeat tests. After a year of participating in the ACO’s care management program, Carson had avoided dialysis and improved his health.

ACOs proactively reach out to patients and help find workable alternatives when treatment plans don’t fit their lives or medications are too expensive.

Real Story: Anna, a diabetic patient, was diagnosed with a new chronic condition and couldn’t afford a new prescription while struggling with the cost of her diabetes medications, so she stopped filling it. Not taking her medication could have led to serious complications. Luckily, Anna was part of an ACO that closely monitors its patients. They saw that her prescription went unfilled and contacted her to find out why. When Anna explained it was too expensive, the ACO’s nurse helped Anna find a patient assistance program and worked with her primary care provider to switch to a new, less costly medication. Anna now has the proper medications she needs within her budget, allowing her to maintain her health and focus on better things like spending time with her grandchildren.

ACO care coordinators develop trusted relationships with their patients, which is key to getting the right care at the right time.
Real Story: Richard, a senior with pulmonary fibrosis, was on a phone call with Sandra, his ACO care advisor when she noticed he was struggling to speak and his breathing had become labored since their previous talk. Drawing on her years of experience as a registered nurse and care management specialist, Sandra urged Richard to call 911 immediately. While Richard didn’t initially think he needed to go to the emergency room, he trusted Sandra after working with her through the ACO’s Complex Care Program. Richard called 911, and he was diagnosed with a pulmonary embolism—a blood clot in the lungs that could have been fatal. Later, Sandra received a call from Richard’s daughter, who was grateful. When asked what might have happened without Sandra, Richard was clear: “I might not be around today.” In the months after his potentially fatal health scare, he continued to work with Sandra to actively manage his disease and better understand when his condition may require urgent medical care.