OSF HealthCare has many accountable care relationships established by Medicare.
Just like the name implies, accountable care means health care organizations are accountable for meeting or exceeding specific Performance and Quality goals.
The goals are defined by the payor and agreed to by identified providers of care.
How the ACO Works with CMS
As an ACO working with Medicare, OSF is assigned a specific number of Medicare beneficiaries.
If the cost of care for those Medicare beneficiaries is greater than the Medicare target, OSF will be required to pay Medicare a percentage of the losses. This is arrangement is referred to as "Shared Risk" or "Shared Losses."
However, if the cost of care for those Medicare beneficiaries is less than the Medicare target, Medicare will pay OSF a percentage of the shared savings. This arrangement is referred to as "Shared Savings."
What Does This Mean for Providers?
Accountable Care Organizations emphasize provider focus on the following:
- Coordinated care among patients’ care team
- Preventative care
- Provider engagement to reduce length of stay and re-admissions
- Collaboration with Care Managers to coordinate social and behavioral health services.
Opportunities to Serve
When health care providers actively participate in the ACO and encourage their patients to participate in their own health care decisions, our mission to serve our patients with the greatest care and love in a community that celebrates the gift of life will be fulfilled.
- Better care – from a comprehensive approach
- Improved value to the patient
- Increased focus on quality and patient experience
Simply put, through the ACO model, we can achieve the CMS three-part aim:
- Better health (for populations)
- Better care (patient experience and outcomes)
- Better healthcare cost control