How to prepare for ACO practice

"Coordinated care is clearly an emerging trend in health care."

When health care historians look back on the year 2014, it may be remembered as the year coordinated care had its first growth spurt.

Medicare has moved quickly to establish accountable care organizations (ACO) throughout the country. Other public and private health plans are eyeing innovative new coordinated care models such as patient-centered medical homes (PCMH).

"Coordinated care is clearly an emerging trend in health care, just as managed care was a couple of decades ago," says Stephen Montaquila, O.D., chair of the AOA Third Party Center's executive committee. "Just as optometrists then developed or joined managed eye and vision care networks, practitioners now should be considering the prospect of joining or connecting with ACOs or PCMHs."

ACOs are groups of doctors, hospitals and other health care providers who come together voluntarily to offer coordinated care, according to the U.S. Centers for Medicare & Medicaid Services (CMS). ACOs are being encouraged as a way to reduce costs while improving care for Medicare and Medicaid patients.

To assist ODs, the AOA Third Party Center created "Optometrists' Guide for ACO Participation" and the "Accountable Care Guide," both of which are part of the AOA's online ACO Resource Toolkit (member log-in required).

Tools for navigating ACOs

"The Optometrists' Guide for ACO Participation is a first-of-its kind practical implementation and execution guide for optometrists who are interested in participating in ACOs or other types of integrated health systems," says Dr. Montaquila.

The online ACO Resource Toolkit provides convenient access to resources optometrists can use to understand ACOs, identify and approach ACO networks, and provide a full scope of optometric eye and vision care to ACO patients.

The toolkit includes:

  • Background articles on ACOs and other value-oriented health systems
  • Direct links to the websites of major ACO-related organizations
  • Direct links to major ACO industry publications and other ACO resource materials
  • A complete list of existing Medicare-sanctioned ACOs (with key contact persons when available)
  • Examples of "best practice" ACO models that include and properly utilize optometrists
  • Video and PowerPoint presentation slides for use in presentations to ACO administrators
  • Information on a new AOA Third Party Center Access and Integration Team, now being established to assist optometrists with participation in integrated health networks.

Get in on the ground floor

The number of ACOs in the U.S. has grown rapidly. Some 488 ACOs were serving patients around the nation as of July 2013—more than double the number in operation a year earlier, according to a recent report compiled by the Leavitt Partners for the CMS.

The AOA has long advocated for optometrists to be part of ACOs. Congress agreed and made ACOs accountable for all care covered for patients under Medicare Part A and B, including eye care. In the regulatory process, the CMS confirmed any individual or entity—including optometrists, opticians, ophthalmologists and surgery centers—may join ACOs.

Coordinated care models—both government and private sector—are expected to grow over coming years, Dr. Montaquila said. Now would be a good time for optometrists to "get in on the ground floor" of a growing health care movement.

February 3, 2014

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