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.

Prime Accountable Care, LLC is an organization that CMS has approved as an Accountable Care Organization.

No. An ACO isn’t the same as a Medicare Advantage (MA) Plan or Health Maintenance Organization (HMO). You’re still in Original Medicare, and your Medicare benefits, services, rights and protections won’t change. And you still have the right to use any doctor or hospital that accepts Medicare at any time, the same way you do now.

 It’s important to know that:

• You can still go to any doctor, hospital, or other provider that accepts Medicare. Nobody can restrict which providers you see.
• You are still in Original Medicare.
• You are still entitled to all the same Medicare services, benefits, and protections.

To help doctors who participate in an ACO give patients like you the best possible care, Medicare wants to share some additional information about your care with them. This information includes things like doctor, hospital, and pharmacy visits in the past and moving forward. This information helps your doctor and the other ACO providers track the services you’ve already gotten, understand where you may need more care, and find ways to smooth the path for you if you have to transfer in or out of a hospital, or from the care of one doctor to another. If you decide you do not want to have the information about your care shared with the ACO, you can do so.