Accountable Care organizations, or ACOs, were created under section 3022 of the Patient Protection and Affordable Care Act of 2010. The voluntary groups of health care providers and facilities coordinate medical treatment, medication therapy and preventive services for Medicare beneficiaries. Patients receiving services from ACO-member providers see no difference in co-pays, coverage or choice of caregiver.
Pharmacists and ACOs
The PPACA, which is also commonly referred to as Obamacare or the ACA, identifies physicians and other “practitioners” as health care providers eligible to participate in ACOs. The statute relies on practitioner definitions spelled out in the Public Health Service Act, which does not name pharmacists as federally recognized health practitioners.
Despite this legislative oversight, which pharmacist professional organizations are working to correct, pharmacists and pharmacy technician can work within ACOs. CMS encourages hospitals, nursing homes, assisted-living communities and outpatient clinics to team up to form accountable care organizations, so pharmacy professionals and paraprofessionals working in those settings can and will help Medicare beneficiaries treated by ACOs.
Community pharmacies can also join ACOs, and medication therapy management services have been identified as essential to meeting the goals of reducing health care costs, preventing diseases and hospitalizations, and improving patient treatment outcomes and overall quality of life.
Types of Accountable Care Organizations
ACOs operate according to regulations and guidelines from the Centers for Medicare & Medicaid Services. The agency's Center for Medicare & Medicaid Innovation supports that effort and has established three models for accountable care organizations:
Medicare Shared Savings Program -- Open to health care providers and facilities that treat Medicare beneficiaries on a fee-for-service basis.
- Advance Payment Initiative -- Rural health care provider groups can qualify for upfront and monthly payments from CMS to best meet the needs of Medicare beneficiaries.
- Pioneer ACO Model -- Health systems existing before 2010 that coordinate the work of doctors, pharmacists, counselors and other health care providers can qualify as ACOs.
Follow the links from the ACO type names to get details on eligibility, participation and billing. The CMMI awarded a first round of grants for ACO pilot and demonstration programs in the spring and summer of 2012. Regulators have the authority to recognize successful ACOs as standard Medicare-reimbursable care providers.