An Accountable Care Organization (ACO) is a group of doctors and other health care providers working together with Medicare to give you better service and care. The goal of an ACO is for your doctors to communicate closely with your other health care providers to deliver high-quality care and meet your individual needs and preferences. The ACO may be rewarded for providing you with high-quality, more coordinated care.
BJC HealthCare was the first in the St. Louis area to become an Accountable Care Organization. BJC has partnered with many physicians and their practices to better coordinate care and improve the health of our community.
How will an ACO lead to better care for me?
When your health care providers have access to your health information and are able to share that information with one another, they can give you better, more coordinated care. Each of your health care providers will not only know about the health issues that they have treated, they will have a more complete picture of your health through communicating with your other health care providers.
Over time, you should see better, more coordinated health care where you are the center of care and your satisfaction is a goal of the ACO. You may notice that:
You don't have to fill out as many medical forms that ask for the same information
The health care providers that you see all know what is going on with your health because they communicate with each other
You don't have to have the same medical tests done over and over because your results are shared among your health care team
The providers participating in the ACO will become partners with you in making care decisions
Here are things that won't change because your doctor is part of an ACO:
What you pay, your Medicare benefits or the cost of your coverage should not increase
Your right to choose any hospital or doctor that accepts Medicare, at any time, will not change even if that hospital or doctor is not part of an ACO
Some doctor practices may have people that will check on your care. They may call you after an appointment or a procedure to make sure you understand how to take your medicines or schedule follow-up visits. They will also share information with your doctor to make sure you get the right care.
If my doctor's in an ACO, can I still see whatever doctor I want?
Absolutely. If your doctor participates in an ACO, you can see any health care provider who accepts Medicare. Nobody -- not your doctor, not your hospital -- can tell you who you have to see. If you wish to do so, Medicare makes it easy to select your Primary Clinician and Voluntarily Align with an ACO.
Is an ACO a Health Maintenance Organization (HMO), managed care or an insurance company?
No. An ACO is a group of doctors, hospitals and other health care providers who work together to provide you with better, more coordinated care. Doctors and hospitals in an ACO communicate with you and with each other to make sure that you get the care you need when you are sick, and the support you need to stay healthy and well.
An ACO isn't an HMO, managed care or insurance company. Unlike HMOs, managed care or some insurance plans, an ACO can't tell you which health care providers to see and can't change your Medicare benefits. If your doctor participates in a Medicare ACO, you always have the right to choose any doctor or hospital who accepts Medicare at any time.
How do I know if my doctor is in the ACO?
When your doctor is participating in the BJC Accountable Care Organization, you will be notified. This will be done by letter, written information provided to you when you see your doctor, a sign posted in your doctor's office, and will be discussed with you at your next visit. If you aren't sure if your doctor or health care provider is participating in a Medicare ACO, ask him or her.
For general information on ACOs, call toll-free 800.MEDICARE (800.633.4227) 24 hours a day 7 days a week. TTY users should call toll-free 877.486.2048.
What rights do I have if my doctor is in an ACO?
You will continue to receive the same rights enjoyed by all people with Medicare. To help you to get the best-coordinated care, Medicare will share information about your medical information with your doctor, including medical conditions, prescriptions and visits to the doctor. This is important to help the ACO keep up with your medical needs and track how well the ACO is doing to keep you healthy and helping you get the right care.
Your privacy is very important to us. You can tell Medicare not to give your doctor’s ACO information that your doctor needs to coordinate your care by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Unless you take this step, your medical information will be shared automatically with your doctor’s ACO for purposes of care coordination and quality improvement. Medicare won't share information about anyone who has ever received treatment for alcohol or substance abuse without written permission.
Medicare will also be following up with people with Medicare to ask about your experiences as a patient of a doctor who is participating in a Medicare ACO. As time gets closer, you will get a letter to let you know the survey is genuine. Medicare will use your feedback to help make sure you get high-quality care.
Who can read my medical information? And will it be protected?
The group of doctors, hospitals and other health care providers working together in the BJC Accountable Care Organization will be able to read your medical records, along with other office staff authorized to help coordinate your care. The privacy and security of your medical information is protected by federal law. Contact your doctor's office for more information about how they protect your medical information, or call toll-free 800.MEDICARE (800.633.4227) 24 hours a day/7 days a week. TTY users should call toll-free 877.486.2048.
Where can I find more information about ACOs?
For more information about ACOs, you can: