An Accountable Care Organization (ACO) is a network or group of hospitals, doctors and other health care providers that come together to share financial and medical responsibility for providing coordinated care to Medicare patients. The goal of an ACO is to limit unnecessary spending while ensuring that patients receive high-quality care. When an ACO successfully delivers high-quality patient care and spends health dollars wisely, its providers will share in the savings that it achieves for the Medicare program. On the other hand, if an ACO misses its spending targets, it will share in the losses and must refund Medicare.
The COVID-19 pandemic is causing numerous concerns among ACOs, who will likely see strain on their health systems as more patients become infected with the virus. One of the main causes for concern is the uncertainty of rising costs, which will put ACOs at greater risk for financial losses and affect their ability to earn shared savings. Many of these providers are not equipped to pay large sums of money to the government due to increased costs from COVID-19.
ACOs are also concerned about how the pandemic will affect their ability to meet quality metrics for which they typically get financial rewards. To avoid significant losses, ACOs are looking for short term revenue opportunities, and adapting payment models.
Over the months of March and April 2020, Within Health engaged with 20 national Medicare ACOs of various sizes across different states to better understand how the global pandemic is impacting their businesses. Based on their findings, Within Health created a comprehensive report that includes the anticipated impact on cost and quality metrics, as well as a summary of in-flight initiatives across three major areas: technology investments, operating model changes, and provider support.
In addition to detailing which cost and quality metrics ACOs expect to be the most impacted, the report also covers how these organizations plan to mitigate shared losses, implement telemedicine into their practices, and evolve their operating models to provide the greatest value to patients and providers.