Chronic Care Coordination and Accountable Care Organizations

Background

A chronic condition or illness is one that is likely to last more than one year, requires ongoing medical attention, and can limit a person’s daily activities. Arthritis, emphysema, cancer, cardiovascular disease, depression, diabetes, and obesity are among the most prevalent chronic conditions in older adults. The number of older people with chronic diseases and conditions is large and growing. In 2014, about 60 percent of adults age 18 and older had at least one chronic condition, and about 28 percent had three or more chronic conditions.

Managing chronic conditions is costly for patients and payers. Despite some progress, there are large deficiencies in the delivery and quality of health care for chronic illness. Addressing the poor quality of treatment for chronic conditions and its high cost is a compelling need.

Monitoring treatment and coordinating care provided by multiple practitioners is key to chronic-care management. This helps to ensure that patients receive timely, appropriate care, while also avoiding unnecessary duplication of services and preventing medical errors. For some patients with multiple chronic conditions, meeting this objective requires a full range of medical and social support services.

Monitoring and coordination can increase quality and reduce health care costs by ensuring that patients receive recommended services when needed, avoid duplication of services, have providers who monitor their medications, and receive information to help them manage their conditions without exacerbating them.

Beneficiaries can help maintain and improve their health through healthy behaviors. Those with chronic conditions can learn to manage them by taking recommended preventive measures to avoid the onset or exacerbation of illness and to recover from setbacks. Most patients will need assistance to manage their conditions and pursue healthy behaviors; such assistance can be provided by medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. . In traditional MedicareTraditional Medicare, also known as Original or Fee-For-Service Medicare, works on a fee-for-service basis. This means that you can go to any doctor or hospital that accepts Medicare, anywhere in the United States, and Medicare will pay its share of the bill for any Medicare-covered service it… , numerous barriers hamper widespread, sustained improvements in caring for people with chronic conditions. These include:

  • failure to value team-based primary care;
  • fragmentation of care delivery and poor transitions across settings;
  • misaligned fee-for-service payment incentives that do not value service integration;
  • lack of interoperable electronic health information systems, which makes it difficult for providers to monitor patient progress, share information, and track patients over time; and
  • inadequate medication management that can lead to increases in preventable drug-related problems.

Addressing these barriers requires multiple interventions aimed at providers, patients, and family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. , such as coordinated care, self-care management, and transitional care.

Coordinated care interventions include self-management by patients, ongoing monitoring of a person’s health and long-term care needs, and systems to ensure smooth transitions among care settings and providers. Coordinated care programs typically involve support for patients, medication management, improved communication, and coordination among providers.

Self-care management interventions include activities that provide patients (and their caregivers, when indicated) with information and strategies to manage and coordinate their care to improve their quality of life, increase functioning and independence, make more efficient use of health services, and help to lower costs.

Transitional care interventions reduce problems that occur when patients move from one setting to another. Those with chronic conditions are vulnerable if health care facilities and clinicians fail to plan for transitions by not providing follow-up services. Patients at risk for difficult transitions—such as those from hospital to home or nursing facility—include people who have five or more chronic conditions, a need for numerous office visits, poor health status, limitations in daily activities, or a low level of engagement in their care. Transitional care models assign a transitional care manager, such as a nurse or other trained health professional, to coordinate and monitor care and to provide patient and caregiver education and support.

The Centers for Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… & Medicaid Services (CMS) has sponsored many chronic-care demonstrations to explore ways to improve care coordination without increasing costs. They have used different approaches such as care management, disease management, and medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. . The ACA Comprehensive health care reform legislation passed by Congress and signed into law on March 23, 2010. expands the number and type of Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… projects that test ways to coordinate care and ensure smooth transitions for beneficiaries—including those with chronic conditions. These projects include:

  • the Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… Community-Based Care Transitions Program;
  • the Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… Independence at Home Demonstration;
  • using community health teams to support medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. , regardless of payer type; and
  • implementation of incentives to reduce Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… hospital readmissions.

Several states are also implementing various approaches to improving chronic-care coordination.

Emerging models of service delivery—research indicates that the integration of service delivery systems and the coordination of services can lead to more effective—and more efficiently delivered—health care than that provided by the current fragmented delivery system. Integrated systems employ a range of techniques to achieve these positive results, including the provision of decision support tools to clinicians, the use of team-based care, and activities that encourage patient engagement.

An accountable care organization A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. ( ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. ) is a payment and service delivery model in which groups of physicians, hospitals, and other health care providers take responsibility for the cost and quality of care provided to a patient population. Many private insurance companies have implemented ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. programs, using a variety of payment designs and the traditional MedicareTraditional Medicare, also known as Original or Fee-For-Service Medicare, works on a fee-for-service basis. This means that you can go to any doctor or hospital that accepts Medicare, anywhere in the United States, and Medicare will pay its share of the bill for any Medicare-covered service it… program has also established several ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. programs. Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… beneficiaries who receive care from an ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. provider may also obtain Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… -covered services from providers who are not affiliated with the ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. .

ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. are characterized by a payment model that typically ties payment to performance on quality measures and includes financial incentives to constrain the total cost of care for an assigned population of patients. Some examples include “shared savings” models in which the ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. receives a financial reward if the total amount the insurer pays for services for the covered population during a year is below a specified target amount. Depending on the model, the ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. may also be at risk for costs above specified levels.

Many questions remain about the most appropriate ways to ensure that ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. provide high-quality services at a reduced cost. Some analysts believe that ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. may exacerbate a growing trend toward consolidation among provider groups, which can potentially lead to higher prices for medical services by reducing competition and in turn, generating higher costs for private and public insurers. Higher costs could negate potential savings from ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. ’ gains in efficiency.

Possible responses that address this concern include stronger antitrust regulation and enforcement, effective monitoring of quality metrics, and proper oversight (see also this chapter’s section on Antitrust in Health Care).

To be successful, ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. must demonstrate their commitment to high-quality patient experience and reduced costs. A major issue with regard to ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. is how patients would participate in one, and whether they should be informed of their physician’s decision to join one. Some analysts believe that Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… beneficiaries should be prospectively assigned to an ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. based on historical claims data about their past receipt of services from a given physician. In a voluntary scenario, a beneficiary would be informed of his or her assignment and could decide to remain with the provider/ ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. or select another physician outside of the ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. . Others propose that patients should be retrospectively assigned to ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. , as determined by their service use during the time corresponding to the payment period. However, in this last scenario, beneficiaries would not be informed about the delivery system in which they were receiving care.  Medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. also known as patient-centered medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. are team-based primary care practices that provide comprehensive, coordinated, and cost-effective care with the goal of optimizing patients’ health outcomes. Medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. adopt a “whole person” approach to improving care through enhanced access, coordination, and support for patient self-management that is culturally appropriate, interactive, and respectful.

To date, research evidence is lacking as to whether medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. consistently improve outcomes and lower costs and, if so, which specific features bring about these changes.

CHRONIC-CARE COORDINATION AND ACCOUNTABLE CARE ORGANIZATIONS: Policy

Quality of care for Medicaid and Medicare beneficiaries

In this policy: FederalState

AARP supports systems and strategies that help people of all ages maximize function, independence, and well-being, and adapt to changes as their medical conditions and needs change. To this end, AARP supports policies that will lead to improvement of the quality of care for people with chronic conditions

Congress and the states should support evidence-based models for service delivery, as well as demonstration and pilot projects, to identify models most effective in serving Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… beneficiaries, including people with multiple chronic conditions.

Congress should authorize, and CMS should implement payment incentives, public reporting of provider and institutional performance, and other approaches that encourage:

  • coordination of care to ensure effective transitions across care settings; and
  • patient and caregiver involvement through appropriate education, self-management programs, and improved patient-provider communication.

Quality care for chronic illness

In this policy: FederalState

Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… and Medicaid policies should result in the efficient delivery of optimal care for beneficiaries with chronic illness and disabling conditions.

These policies should encourage best practices including:

  • appropriate use of evidence-based interventions,
  • interdisciplinary care teams composed of health and long-term services and supports ( LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… ) professionals and others to support the needs of each patient and their family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. (see also this chapter’s section on Health Care Workforce and Education for more on adequate training of health professionals),
  • periodic assessment of a patient’s clinical needs (grounded in evidence-based protocols when available) and assessment of social and support needs and resources of both patient and family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. as needed,
  • appropriate use and timely monitoring and reconciliation of medications, and
  •  support to family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. to help them partner effectively with professionals.

These policies should also encourage additional best practices including:

  • greater affordability of medications;
  • accelerated adoption of health information technology that contributes to improved care;
  • rapid dissemination of information and adoption of effective, evidence-based chronic-care interventions;
  • greater emphasis on chronic-care coordination and management in clinical education and continuing education of health care professionals; and
  • effective use of the health care workforce (see this chapter’s Section -  Health Care Workforce and Education).

Integrated financing for the delivery of health and long-term services and supports

In this policy: FederalState

Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… and Medicaid should facilitate joint funding streams to enable the coordinated delivery of health services and long-term services and supports Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… ( LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… ) for beneficiaries who are enrolled in both programs.

The federal government should strengthen the incentives for Accountable Care Organizations to coordinate with LTSS Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… providers.

Lifting budget-neutrality requirements

In this policy: FederalState

Budget-neutrality requirements should be eliminated for current and future Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… and Medicaid demonstrations regarding care coordination and medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. for beneficiaries with chronic conditions. Instead, a long-term, multiyear timeframe should be applied when determining the budget impact of these demonstrations.

Beneficiary protections

In this policy: FederalState

Beneficiary and provider participation in chronic-care coordination programs and medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. should be voluntary, should entail no additional cost to beneficiaries, and should not affect access to other Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… benefits.

Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… and Medicaid beneficiaries must be permitted to opt out of participation if they are automatically enrolled in chronic-care programs, Accountable Care Organizations ( ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. ), or medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. .

Chronic-care coordination programs and medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. in Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… should include strong beneficiary protections.

Patients should receive complete information about the program’s objectives, roles, and responsibilities for patients and clinicians; how and where to receive services; which services are beyond the scope of the program; and how to obtain such services.

Physicians, other practitioners, and providers currently providing care should be made aware of beneficiary participation in these programs to facilitate care coordination.

Beneficiary access to other providers should not be restricted. Beneficiary privacy must be protected.

Protections for patients with disabilities, particularly cognitive impairments, should be explicitly addressed.

Incentives

In this policy: FederalState

Chronic-care programs should be permitted to include the following:

  • rigorous evaluations of demonstrations and pilot programs that focus on coordinated care services, and
  • various levels of incentives, including nominal financial and other incentives, to encourage enrollment and participation—incentives should be permitted to vary for different target populations.

Medical homes

In this policy: FederalState

A medical home should include voluntary patient selection of a primary provider or medical practice and should maintain an individual’s ability to change primary providers or medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. .

In advance of receiving care from a medical home, patients should receive information about their rights and responsibilities as medical-home patients.

Medical homes A patient-centric approach to delivering medical care in which a clinician or clinical practice (physician- or nurse-led) assumes responsibility for coordinating, integrating, and enhancing access to needed services for the patient, including self-management and self-efficacy. should have the following attributes:

  • ease of patient and caregiver access and communication, including during nonbusiness hours;
  • periodic assessment of a patient’s clinical needs (grounded in evidence-based protocols when available, and assessment of social and support needs and resources of both patient and family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. as needed), and
  • care management, preferably employing an interdisciplinary team approach, especially for patients with multiple chronic conditions.
  • education and training for patients and their family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. in support of patient self-management and consumer engagement; and
  • capacity to use data to identify patients with specified conditions and risk factors, compile patient registries, track referrals and test results, and follow up with other providers, including community resources.

Preferred approaches rely on health information technology such as interoperable electronic medical records and electronic prescribing.

Accountable Care Organizations

In this policy: FederalState

Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… should continue to test multiple types of ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. to determine which models achieve improved quality and reduced costs.

Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… patients should be assigned prior to the period (the “performance period”) for which Accountable Care Organizations ( ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. ) will be held responsible.

If Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… relies on attribution-based beneficiary assignment to ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. , CMS should allow for voluntary attestation by beneficiaries that they receive care from a participating ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. provider.

Full disclosure about the provider’s participation in the ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. and the impact of such participation on patients must occur to ensure that patients understand and can actively engage in their care.

CMS must ensure transparency of information on quality and cost.

Participation in an ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. by beneficiaries of Medicaid and traditional MedicareTraditional Medicare, also known as Original or Fee-For-Service Medicare, works on a fee-for-service basis. This means that you can go to any doctor or hospital that accepts Medicare, anywhere in the United States, and Medicare will pay its share of the bill for any Medicare-covered service it… should be voluntary and should not affect access to other Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… providers, physicians, or practitioners.

ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. should be required to meet qualifying criteria identified and enforced by a regulatory body. If the regulatory body wishes to deem the accreditation standards of a private accrediting body, the standards must be at least as rigorous as those established by a state or federal regulator.

An ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. must have:

  • a formal legal structure to allow the organization to receive and distribute payments, a mechanism for governance, and a governing body that includes consumers;
  • the capacity to manage risk and resources to ensure accountability;
  • an adequate provider network, including a strong foundation in primary care that can function as a medical home;
  • ability to coordinate services across the continuum of care and care settings;
  • ability to meet the requirements of (at least) stage one of federal “meaningful use” regulations to demonstrate that use of health information technology improves care (see this chapter’s Section -  Reforming the Delivery of Health Care Services—Health Information Technology), and to use technology to support clinical operations and patient-centered functions (e.g., through email and tele-health The use of electronic communications technologies and information to support and offer health care when distance separates patient from provider. Also sometimes referred to as telemedicine.  ) in accordance with the provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, in order to be eligible for financial assistance to purchase electronic medical records, eligible physicians and hospitals must demonstrate “meaningful use” of technology to achieve significant improvements in care;
  • capability to measure and report performance, based on quality and cost (resource use); and
  • demonstrated ability to improve quality, including the establishment of performance goals and targets and collection of data to support improved care.

ACOs A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. must collect and report performance data on clinical effectiveness and patient experience.

Aggregate cost-sharing charges in an ACO A model of health care that consists of a group of providers who will be held responsible for the cost and quality of care a population of individuals receives. should not exceed those in traditional MedicareTraditional Medicare, also known as Original or Fee-For-Service Medicare, works on a fee-for-service basis. This means that you can go to any doctor or hospital that accepts Medicare, anywhere in the United States, and Medicare will pay its share of the bill for any Medicare-covered service it… .