Prime ACO For Beneficiaries
Prime ACO Beneficiaries
Your primary care doctor and other providers who are providing care to you will communicate with each other and partner with you in making health care decisions.
- You may spend less time filling out medical history paper work because your doctor(s) may already have this information in an electronic health record.
- You’ll likely have fewer repeated medical tests because your doctor(s) and hospital(s) will share information and coordinate your care.
- You’ll be in the center of care, and your doctor(s) will be better able to keep you informed, as well as listening and honoring your choices.
Unlike HMOs, managed care, or some insurance plans, an ACO can’t tell you which health care provider(s) to see and cannot change your Medicare benefits.
Q: What is an ACO?
An Accountable Care Organization (ACO) is a group of doctors and other healthcare providers who agree to work together with Medicare to give you the best possible medical care. ACOs may take different approaches to giving you coordinated care. Some ACOs may have special case managers that help you set up appointments or make sure your medications are in order when you enter or leave a hospital. Other ACOs may help your doctors get you equipment for monitoring your medical conditions better at home via tele-health and tele-medicine, if you need it. Most ACOs use advanced systems that let them more carefully coordinate your care, and make sure your doctor has the most up-to-date information about your health.
The goal of the ACO is to support your doctor in caring for you by making sure they have the most up-to-date information about your health and your care. For you, this means your doctors communicate better with each other, and you avoid having duplicate tests or answering the same questions over and over.
Working together, your doctors can do more to follow your health, make sure you get the best possible care, and may hire additional staff to help meet your unique care needs, depending on what works best for you.
Doctors and other healthcare providers choose to participate in an ACO because they’re committed to providing you with a better care experience. They may also be rewarded for offering you better, more coordinated, care. If your doctor chooses to participate in an ACO, you will be notified either in person or by letter.
Q: Who is Prime Accountable Care, LLC?
Prime Accountable Care, LLC is an organization that CMS has approved as an Accountable Care Organization.
Q: If my doctor is in an ACO, can I still see whichever doctor I want?
Absolutely—if your doctor participates in an ACO, you can see any health care provider who accepts Medicare. Nobody— not your doctor, not your hospital—can tell you who you have to see.
Q: Is an ACO a Health Maintenance Organization (HMO), managed care, or an insurance company?
No. An ACO is a group of doctors, hospitals, and other health care providers who work together to provide you with better, more coordinated care. Doctors and hospitals in an ACO communicate with you and with each other to make sure that you get the care you need when you’re sick and the support you need to stay healthy and well.
An ACO isn’t an HMO, managed care, or insurance company. Unlike HMOs, managed care, or some insurance plans, an ACO can’t tell you which health care providers to see and can’t limit your Medicare benefits. If your doctor participates in a Medicare ACO, you always have the right to choose any doctor or hospital who accepts Medicare at any time.
Only people with Original Medicare can be assigned to an ACO. You can’t be assigned to an ACO if you have a Medicare Advantage Plan (like an HMO or a PPO).
Q: How do I know if my doctor is in an ACO? What should I expect if my doctor is in an ACO?
If your doctor or health care provider chooses to participate in an ACO, you’ll be notified. This notification might be a letter, written information provided to you when you see your doctor, a sign posted in a hospital, or it might be a conversation with your doctor the next time you go to see him or her.
If you aren’t sure if your doctor or health care provider is participating in a Medicare ACO, ask him or her. For general information on ACOs, call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
Over time, if you see a doctor or health care provider participating in an ACO, you may notice that:
- You don’t have to fill out as many medical forms that ask for the same information.
- The health care providers that you see all know what’s going on with your health because they communicate with each other.
- You don’t need to repeat medical tests because your results are shared among your health care team.
- The providers participating in the ACO will work with you to make sure the care decisions reflect your preferences.
Your Medicare benefits won’t be limited because your doctor is part of an ACO. Also, you still have the right to choose any hospital or doctor that accepts Medicare, at any time, even if that hospital or doctor isn’t part of an ACO.
Some ACOs may hire people to help check on your care. They may call you after an appointment or a procedure to make sure you understand how to take your medicines or schedule follow-up visits. They may also share information with your doctor to make sure you get the right care.
Q: What rights do I have if my doctor is in an ACO?
You’ll continue to get the same rights all people with Medicare get. To help you to get the best-coordinated and highest quality care, Medicare will share certain information about your medical care with your doctor’s ACO, including medical conditions, prescriptions, and visits to the doctor. This is important to help the ACO keep up with your medical needs and track how well the ACO is doing to keep you healthy and helping you get the right care.
Your privacy is very important to us. You can tell Medicare not to give your doctor’s ACO information that your doctor needs to coordinate your care by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Unless you take this step, your medical information will be shared automatically with your doctor’s ACO for purposes of care coordination and quality improvement.
If you’re now getting or received treatment in the past for alcohol or drug abuse, Medicare won’t share any information about that treatment with any ACO unless the you give Medicare your written permission to do so.
Also, you may get a follow-up survey to ask about your experiences as a patient of a doctor who’s participating in a Medicare ACO. You’ll get a letter to let you know the survey is genuine. The ACO will use your feedback to help make sure you get high quality care.
Q: Who can read my medical information, and will it be protected?
The group of doctors, hospitals, and other health care providers working together in the ACO will be able to read your medical records, along with other office staff authorized to help coordinate your care.
The privacy and security of your medical information is protected by federal law. Contact your doctor’s office for more information about how they protect your medical information, or call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
Q: How will an ACO lead to better care for me?
When your health care providers have access to your health information and are able to share that information with one another, they can give you better, more coordinated care. Each of your health care providers won’t only know about the health issues that they’ve treated, they’ll have a more complete picture of your health through communicating with your other health care providers.
When your health care providers participate in an ACO, you should see better, more coordinated care over time. With an ACO, you’re the center of care, and your satisfaction is one of their goals.
Q: Where can I find more information about ACOs?
For more information about ACOs:
- Visit CMS.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/
- Visit Medicare.gov/manage-your-health/coordinating-your-care/accountable-care-organizations.html
- Talk to your doctor
- Call 1-800-MEDICARE 24 hours a day, 7 days a week.