Accountable Care Organization

What is an Accountable Care Organization (ACO)?

An Accountable Care Organization (ACO) brings health care providers together to provide comprehensive health services to Medicare beneficiaries. At the center of a successful ACO is strong physician leadership that coordinates effective care and preventative services to keep Medicare beneficiaries healthy. All participating providers in the ACO—primary care, hospitals, specialists, and others—share the responsibility of coordinating patient care, with goals to improve care, reduce redundancy and lower costs.

The Northeast Georgia Health Partners ACO includes various affiliated entities, such as Northeast Georgia Health System (NGHS), Northeast Georgia Physicians Group and Longstreet Clinic, that work together to foster collaborative relationships throughout the entire continuum of care and bring greater benefit and value to the Medicare beneficiaries we serve. Health care providers that participate in the Northeast Georgia Health Partners ACO can be found at www.healthpartnersnetwork.com/aco

How does an ACO benefit Medicare beneficiaries?

ACO participating providers are committed to the overall health and wellbeing of the Medicare beneficiaries they serve, which includes preventative services that keep patients healthy. Additionally, instead of Medicare beneficiaries having to coordinate care with providers of varying specialties who operate independently, they have the option to work with a team of ACO participating providers who coordinate care and share information like medical history, conditions and prescriptions. Care coordination aids in preventing unnecessary, duplicative, and costly tests or treatments.

ACOs are especially beneficial for Medicare beneficiaries who have chronic illnesses such as diabetes, high cholesterol or high blood pressure because these beneficiaries likely see multiple specialists and physicians. In an ACO, participating providers are talking to each other to ensure they coordinate the most effective care and treatment for the Medicare beneficiary.

What’s the difference between an ACO and an HMO?

Both ACOs and Health Maintenance Organizations (HMOs) operate a network of providers, but there are some key differences. One of the most notable is that, in an HMO, patients incur additional costs if they see providers outside of their HMO network. Participating providers within an ACO will refer patients to other ACO participating providers, but Medicare beneficiaries can still see Medicare-approved providers outside the ACO without the ACO limiting their benefits.

How do I join an ACO?

You don’t join an ACO, your providers do. Unlike health insurance, Medicare beneficiaries do not enroll in an ACO. Rather, participating providers come together to form an ACO for their Medicare beneficiaries, following guidelines from Medicare.

If you are a Medicare beneficiary not enrolled in a Medicare Advantage plan, Medicare may assign you to an ACO based on where you receive primary care services. However, you have the choice to see another provider outside the ACO who accepts Medicare. Should Medicare assign you to the Northeast Georgia Health Partners ACO, you will receive notification from our ACO about what that means.

Contact information for beneficiaries with general questions about the Shared Savings Program:

Medicare contact information:

  • 1-800-MEDICARE (1-800-633-4227)
  • Teletypewriter users should call 1-877-486-2048

ACO Contact Information:

  • 770-219-6600