Medicare Accountable Care Organizations: Steps to Getting Started

While the excitement surrounding Medicare Accountable Care Organizations (ACO) is clearly reverberating throughout the physician community, there continues to be a significant knowledge gap regarding the basic steps that must be taken to form an ACO. While a blog cannot provide a full step-by-step guide to ‘getting started’, I will address the relevant key considerations and provide the resources you need to move toward the formation of an ACO.

First, it’s important to take some time to understand the overall ACO model and trends and the specifics as they relate to Medicare. The MTBC webinar will help you understand the former (i.e., general overview); as to the latter (Medicare ACO), take some time to review the AMA webinar. The following overview document may also be helpful.

Second, while there are three Medicare payment models, it’s particularly important that you understand the Medicare shared savings program. The following are the minimum prerequisites for participating in the program:

  • 5,000+ Medicare beneficiaries
  • Sufficient number of primary care providers to care for the assigned beneficiaries
  • Three year agreement with Medicare
  • Identification of ACO providers and a certification supporting their commitment to being accountable for quality, cost and overall care
  • Appropriate governance and management structure to support the accomplishment of ACO objectives

To learn more about the above and additional requirements, please review “Accountable Care Organizations: What Providers Need to Know.”
In my next blog, I’ll be addressing the final three matters that must be taken into account by anyone who is considering the possibility of forming an ACO.