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In the United States, accountable care organisations (ACOs) – a group of providers that take responsibility for providing all the care for a given population for a specified period of time – have been developed to provide a more integrated approach to care.
and this:
Accountable Care Organizations are groups of clinicians, hospitals and other health care providers who come together voluntarily to give coordinated high-quality care a designated group of patients.
In the United States, accountable care organisations (ACOs) – a group of providers that take responsibility for providing all the care for a given population for a specified period of time – have been developed to provide a more integrated approach to care.
and this:
Accountable Care Organizations are groups of clinicians, hospitals and other health care providers who come together voluntarily to give coordinated high-quality care a designated group of patients.[/QUOT
Yes, saw all of that. But I guess I am a knucklehead... not clear enough for me. How does it work?
These have been discussed for several years here. Search C-D for "Accountable Care Organization"
From 08-06-2023:
Quote:
Originally Posted by Ariadne22
n April last year, the Biden administration contracted with 53 third-party companies to mandate privatized health care plans through Medicare. The resulting health care options are effectively Medicare Advantage plans, or private coverage offered through the national health insurance program for seniors and people with disabilities — but with one wrinkle: Patients are being assigned to these new plans without their consent.
The 53 participating companies — called “direct contracting entities,” or DCEs — are allowed to offer benefits beyond traditional Medicare, like gym membership coverage. But as for-profit businesses that receive a set payment from Medicare no matter how much care they approve, these DCEs are incentivized to limit the care that patients receive, especially when they are very sick. The first DCEs were launched by President Donald Trump in 2019, and so far, at least 350,000 seniors have already been moved onto these privatized Medicare plans.
While the DCE program was launched under President Trump, Biden expanded the effort in February under a new name: the Accountable Care Organization Realizing Equity, Access, and Community Health program, or “ACO REACH.”
Now, hospital-backed for-profit health benefit programs are also allowed to automatically enroll Medicare patients into their health care plans.
Like providers of Medicare Advantage plans, these new firms receive a set payment from Medicare for their offerings, supposedly to incentivize more holistic and better care. In exchange, these firms acquire Medicare patients in their plans — often without the patients realizing what is happening.
In March, The Lever reported on how one Medicare beneficiary who was quietly assigned to a DCE initially misinterpreted a message she received about the shift as a health-related communication from her doctor — despite being an experienced health policy expert.
Along with the 15 private equity-backed companies, the list of approved DCEs the Biden administration released in April 2021 includes 15 operations owned by health care giants, such as insurers Humana, UnitedHealth, and Anthem, the pharmacy chain Walgreens, and the dialysis provider DaVita.
Once again, both of the above situations - especially that of OP's hubby - sound like the implementation of CMS 'pilot' Direct Contracting Entity program wherein one can be automatically enrolled in your PCP's DCE should said PCP be a participant. Presumably, one should be given the 'option' of enrolling (hubby was), but not all are as we've learned. Hubby wisely declined.
OP's hubby's doc is apparently now connected to a DCE - which profits said doc will share in. Pleaseread the below links which explain how DCE's will operate - everyone on Medicare should be aware of the future of Medicare itself - i.e., managed care by for-profit entities:
It's a way of off-loading Medicare participants into an HMO/Medicare Advantage type plan whilst technically keeping them on Original Medicare.
For clarification purposes, ACO and DCE's are not the same thing.
Quote:
Originally Posted by villabella22201
Yes, saw all of that. But I guess I am a knucklehead... not clear enough for me. How does it work?
Are you familiar with VHC and HCA in your neck of the woods? If so, you know how they have hospitals and emergency rooms but also have primary care doctors and specialist working out off non-hospital offices. They still use the VHC or HCA name and many of their services are linked between the hospital, clinics, ambulatory care and specialist so you can seamlessly transition from a Primary care situation to a specialist to test and lab work and everything while still being within their parent healthcare system.
You are not obligated to use any of their providers or any of their offered services. You are free to use any Medicare or non Medicare provider if you like. The advantage is that in some settings, if a specialist is needed, it's a seamless referral and often the refereeing doctor can even make the appointment directly in their system.
Essentially, consider it like an all inclusive resort stay where everything you want is right there for the asking. Unlike an HMO or some DCE's, you are under no obligation to stay within that ACO for anything.
For clarification purposes, ACO and DCE's are not the same thing.
Are you familiar with VHC and HCA in your neck of the woods? If so, you know how they have hospitals and emergency rooms but also have primary care doctors and specialist working out off non-hospital offices. They still use the VHC or HCA name and many of their services are linked between the hospital, clinics, ambulatory care and specialist so you can seamlessly transition from a Primary care situation to a specialist to test and lab work and everything while still being within their parent healthcare system.
You are not obligated to use any of their providers or any of their offered services. You are free to use any Medicare or non Medicare provider if you like. The advantage is that in some settings, if a specialist is needed, it's a seamless referral and often the refereeing doctor can even make the appointment directly in their system.
Essentially, consider it like an all inclusive resort stay where everything you want is right there for the asking. Unlike an HMO or some DCE's, you are under no obligation to stay within that ACO for anything.
Thank you, yes, that helps to clear it up.
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