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The ABCs of ACOs

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Healthcare Changes and the Affordable Care Act

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Abstract

The Affordable Care Act hastened the emergence of a new healthcare delivery and payment model called Accountable Care Organizations (ACOs). ACOs are groups of healthcare providers linked through a common governance structure that are responsible for serving “aligned” patients who seek most of their primary care from those providers. ACOs also include a shared savings opportunity – if providers can manage costs associated with aligned patients underneath a pre-determined benchmark, while meeting quality performance expectations, they can access savings. Based upon provisions in the Affordable Care Act, CMS initiated two Medicare ACO programs in 2012, discussed in detail in this chapter: the Medicare Shared Savings Program (MSSP) and the Pioneer ACO Program. While novel programs, the ACO concept draws upon a lengthy political and health policy history, also reviewed herein.

A straight line may be the shortest distance between two points, but it is by no means the most interesting.– Doctor Who

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Abbreviations

ACA:

Affordable Care Act

ACO:

Accountable Care Organization

AMA:

American Medical Association

BBA:

Balanced Budget Act

CMMI:

Centers for Medicare and Medicaid Innovations

CMS:

Centers for Medicare and Medicaid

E&M:

Evaluation and Management [Codes]

ESRD:

End Stage Renal Disease

FFS:

Fee-for-Service

FQHC:

Federally Qualified Health Center

HHS:

Health and Human Services

HMO:

Health Maintenance Organization

IPA:

Independent Practice Association

MedPAC:

Medicare Payment Advisory Commission

MMA:

Medicare Modernization Act

MSSP:

Medicare Shared Savings Program

NPRM:

Notice of Proposed Rulemaking

PGP:

Physician Group Practice demonstration

PPO:

Preferred Provider Organization

PSO:

Provider Sponsored Organization

SGR:

Sustainable Growth Rate

TIN:

Tax Identification Number

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Authors and Affiliations

  1. Care Management Organization, Montefiore Medical Center, 200 Corporate Boulevard, Yonkers, NY, 10701, USA

    Hope Glassberg & Anne Meara BSN, MBA

  2. Department of Medicine, Division of Geriatric Medicine and Palliative Care, NYU School of Medicine, NYU Langone Medical Center, 530 First Avenue, BCD612, New York, NY, 10016, USA

    Carolyn S. Blaum M.D., MS

  3. Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY, 10467, USA

    Laurie G. Jacobs M.D.

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  1. Hope Glassberg
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  2. Anne Meara BSN, MBA
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  3. Carolyn S. Blaum M.D., MS
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  4. Laurie G. Jacobs M.D.
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Correspondence to Laurie G. Jacobs M.D. .

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  1. Vanderbilt University School of Medicine, Nashville, Tennessee, USA

    James S. Powers

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Glassberg, H., Meara, A., Blaum, C.S., Jacobs, L.G. (2015). The ABCs of ACOs. In: Powers, J. (eds) Healthcare Changes and the Affordable Care Act. Springer, Cham. https://doi.org/10.1007/978-3-319-09510-3_4

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  • DOI: https://doi.org/10.1007/978-3-319-09510-3_4

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