Coordinating your care
Coordinating care across multiple providers can improve your treatment and health outcomes. Coordinated care:
- Eliminates redundant tests and services (when getting the same service more than once isn't necessary)
- Prevents medical errors
- Ensures information is shared across all providers to deliver more effective care
Medicare's coordinated care programs include:
Does Medicare cover care navigation or chronic care management services?
Accountable Care Organizations
An Accountable Care Organization (ACO) is a group of doctors, hospitals, and/or other health care providers who work together to improve the quality and experience of your care. ACOs provide coordinated care for you to get well and stay well.
- You get patient-centered care focused on your needs.
- Your health care providers can see the same test results, treatments, and prescriptions.
- More coordination helps prevent medical errors and drug interactions.
- You may save time, money, and frustration by avoiding repeated tests and appointments.
- Better communication can help protect against Medicare fraud and waste.
ACO providers communicate with each other and partner with you in making health care decisions. They share information and may use Electronic Health Records (EHRs) , so you'll likely have fewer repeated medical tests and may save time on paperwork.
Additional ACO Benefits
If your primary care provider participates in an ACO, you may be able to get expanded benefits. For example, in some ACOs, your provider may offer expanded telehealth services. This means you may be able to get some services from home using technology, like your phone or a computer, to communicate in real time with your health care provider. Ask your provider if they offer these services.
In addition, a doctor or other provider who is part of an ACO may be approved to send their patients for skilled nursing facility or rehabilitation care even if they haven’t stayed in a hospital for 3 days first, which is usually a requirement in Medicare. For you to qualify for this benefit, your doctor or other provider has to decide that you need skilled nursing facility care and meet certain other eligibility requirements.
If your primary care provider participates in an ACO and you have Original Medicare, you’ll get a written notice and you’ll see a poster in your provider’s office about their ACO participation. There are now hundreds of ACOs across the country.
How ACOs share information
One of the most important benefits of an ACO is that your doctors and other providers can communicate and coordinate your care. To help with that, Medicare gives your health care provider’s ACO the opportunity to ask for data about your care. Securely sharing your data helps make sure all the people involved in your care have access to the information they need, to get you the care you need.
Medicare protects the privacy of your health information. If you don’t want Medicare to share information with your health care providers for care coordination, call 1-800-MEDICARE (1-800-633-4227). Medicare may still share general information to measure provider quality. For more information on how Medicare may use and give out your information, visit Medicare.gov and search for “privacy.”
ACO Realizing Equity, Access, and Community Health Model
The ACO Realizing Equity, Access, and Community Health (ACO REACH) model helps different kinds of primary care and specialty providers work together to improve the quality of care and health outcomes for people with Original Medicare. If you have Original Medicare and your doctor participates in this model, you may get extra benefits and services to help you stay healthy or better manage a chronic condition. This model also supports care delivery and coordination for people in underserved communities.
How does it work?
If your doctor participates in this model, you’ll get a letter notifying you that your provider is working with an Accountable Care Organization to enhance your care through the ACO REACH Model.
What does it mean for my care?
You’ll still have the same coverage, benefits, and rights that you get through Original Medicare, including:
- Freedom to visit any Medicare provider.
- The option to switch health care providers at any time.
You may also get extra benefits, such as telehealth visits, home care after leaving the hospital, and help with copayments
Are my Medicare rights & benefits protected?
Yes. You’ll still:
- Be able to get care from any provider that accepts Medicare.
- Have access to all of your current Medicare benefits.
- Have the option to switch health care providers at any time.