For Providers

Why an ACO Is Good for Your Practice

The federal government is changing the the basis of reimbursement for all providers of care -- paying for patient outcomes rather than for episodes of care

  • BJC has the ability and resources to leverage its experience with this model, which will help bring more stability to provider reimbursements

  • The core objective is to improve the quality of patient care and provide better health for patient populations while lowering the growth in health care costs

  • This is possible only through better collaboration between hospitals, physician groups and patients

When Your Practice Is a Participant in the BJC ACO

Performance Standards  |  Organization Chart  |  Patient Fact Sheet

  • You can develop more collaborative relationships between hospitals and other physicians

  • More collaboration helps ensure better patient outcomes at more efficient costs while providing opportunities for you to share in Medicare cost savings

  • Initial focus assists in managing patients as part of the Medicare Shared Savings Program

  • Financial incentives are based on patient outcomes, with attention to value and quality of care

  • This is a framework for BJC to support participating physicians and practices

  • BJC will help in developing the systems, resources and services necessary to improve patient and population health, and control costs 

How the Accountable Care Organization Works

  • It enhances access and continuity, thus accommodating patients' needs with:

    • Access and advice during and after hours

    • Enhanced communications with patients and their families

    • More coordination with other providers involved in care

  • It identifies and coordinates patient populations by:

    • Collecting and using data for population coordination

    • Planning and coordinating care

    • Using evidence-based guidelines for preventive, acute and chronic care coordination, including medication coordination

  • It provides self-care support and community resources to:

    • Assist patients and their families in self-care coordination with information, tools, and resources

    • Track and coordinate care, including tests, referrals and transitions of care

  • It measures and improves performance by:

    • Using performance and patient experience data for continuous quality improvement



How This Differs from an HMO

Fee-for-service Medicare patients who see providers who are participating in a Medicare ACO maintain all their Medicare rights, including the right to choose any doctors and providers who accept Medicare.

In the HMO model, HMO physicians:

  • Were paid using a capitated, per-member per-month payment formula for all patients attributed to them

  • Physicians received payment regardless of the number of visits or the quality of care

In the ACO model, doctors:

  • Continue to be paid fee-for-service at the same rates as they are today, however, focus will be on quality and efficiency

  • If the ACO continues beyond 2015, participating hospitals, physicians and other providers will likely be required to assume some financial risk for cost-quality performance

Your Patients' Rights

Regardless of whether a provider chooses to participate in an ACO, their patients with Medicare may continue to see them.

Douglas Pogue, MD, internal medicine, and medical director, BJC ACO, speaks to physicians about how the ACO provides for more coordinated, transparent and well-communicated care in a platform that raises the health status of their patients.