How Do Accountable Care Organizations Affect Medicare Beneficiaries?

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If you are on Medicare, you may have recently been contacted by an Accountable Care Organization and asked for access to your health records and other Medicare information.

ACOs are a new initiative of the federal Centers for Medicare and Medicaid Services to promote the reduction of Medicare costs through improved coordination of patient care. If you have Original Medicare and your doctor has joined an ACO, you should be notified in person or by mail. ACOs can only operate with CMS approval, and your medical information is kept private under federal law.

An ACO is made up of local health providers and hospitals that have volunteered to work together to provide patients with coordinated care. In an ACO, your doctors and other providers will communicate with each other and you so that you can make better, more informed decisions about your health care.

When providers share information you may benefit by having to fill out less paperwork and by having to undergo fewer repeated medical tests. Also, you can be assured that your doctors will be better able to access, understand and honor your health care choices.

In the last five to seven years, health care stakeholders have been talking about incentivizing the coordination of services. ACOs reflect an agreement between the federal government and providers to attempt to accomplish the “triple aim” of the Affordable Care Act:

  1. To improve the patient’s experience (quality and access) and outcomes,
  2. To improve cost-effectiveness and
  3. To proactively consider ways to improve population health as it relates to care.

If an ACO is able to successfully deliver quality health care and provide cost savings, it shares in the savings it achieves for Medicare. It’s important to note that incentivizing coordination of services is not new. Many Medicare beneficiaries will remember when Health Maintenance Organizations (HMOs) came onto the scene. But ACOs are different because quality of care — and not just cost savings — is a central component to realizing the incentive.

SHIIP, the Seniors’ Health Insurance Information Program of the N.C. Department of Insurance, can assist Medicare beneficiaries who have questions about Accountable Care Organizations. For more information about ACO or any other Medicare-related issue, contact SHIIP at 800-443-9354, visit, or call Lenoir County Cooperative Extension at 252-527-2191.