In December, the AARP Public Policy Institute published an article on Medicare Accountable Care Organizations (ACOs). Established by the Affordable Care Act, ACOs are networks of hospitals, doctors, and other health care providers. These networks share a primary goal— to coordinate and improve the quality of, expand access to, and reduce the cost of care for beneficiaries with Original Medicare.
Medicare ACOs are unlike Medicare Advantage (MA) plans in two important ways. First, MA plans have defined provider networks and may impose utilization controls, like prior authorization, on access to particular services or prescription medicines, but ACOs do not. Beneficiaries who receive care from an ACO are encouraged to see doctors within their ACO, but have the option to seek care from any doctor that is part of Original Medicare. Second, Medicare beneficiaries proactively enroll in an MA plan. Original Medicare beneficiaries who are “attributed” to an ACO, however, may not know they are part of the ACO.
Medicare beneficiaries’ quality of care measures appear to have improved for those beneficiaries receiving care from ACOs. Citing empirical research, AARP notes that quality of care improved on multiple measures, including timely access to care, coordination between specialty and primary care, and whether the patient was offered the doctor’s visit notes at the end of an appointment.