What Is an Accountable Care Organization?
An Accountable Care Organization (ACO) is a group of doctors, hospitals, and other healthcare providers that work together to coordinate patient care, improve quality, and manage healthcare spending.
ACOs help care teams work together, but an ACO is not an insurance policy. Your plan determines your coverage, costs, and provider network.
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Care coordination is not the same as insurance coverage
An ACO can help participating providers share information and work toward better outcomes. It does not, by itself, replace a health plan or create a new set of covered services.
Three parts of an accountable care organization
ACOs bring independent parts of a patient's healthcare experience into a coordinated approach. The details vary by ACO program.
Providers work together
Primary care clinicians, specialists, hospitals, and other participating providers can collaborate on treatment and follow-up rather than operating in isolation.
Outcomes are measured
ACOs are evaluated using program-specific measures such as preventive care, chronic-condition management, and patient experience.
Cost and performance matter
Some ACO models offer payments for achieving quality and spending goals. Financial arrangements are between participating organizations and the program.
What changes, and what stays the same?
The ACO is about the organization of care. Insurance rules still come from the patient's actual coverage.
What an ACO can improve
- Better communication among participating providers.
- More attention to follow-up after hospital visits.
- Coordinated preventive services and chronic care management.
- Reduced duplicate services when information is shared effectively.
What an ACO does not automatically do
- It does not replace your insurance policy or plan.
- It does not guarantee lower premiums or out-of-pocket costs.
- It does not automatically expand covered benefits.
- It is not the same as a Medicare Advantage HMO or PPO.
How to find out whether your care team is part of an ACO
Participation may be discussed in your doctor's office or through a notice from an ACO program. Ask questions rather than assuming your insurance rules have changed.
- Ask your primary care officeFind out whether your clinician participates in an ACO and which program applies.
- Ask how your information is usedDiscuss care coordination, referrals, records, privacy, and how the team communicates.
- Check your actual coverageReview your plan documents or Medicare coverage rules for costs, provider access, authorizations, and covered services.
Questions people ask about ACOs
Is an ACO the same as an HMO?
No. An ACO is a provider arrangement focused on coordinated care and accountability. An HMO is a type of health insurance plan with its own coverage and network rules.
Will joining an ACO change my Medicare coverage?
Participation in a Medicare Shared Savings Program ACO does not change Original Medicare benefits. Patients retain the freedom to choose Medicare-participating providers, subject to the ordinary rules for their coverage.
Do I pay a separate fee to belong to an ACO?
In the Medicare Shared Savings Program, you do not pay a separate ACO membership fee. Your normal healthcare coverage and cost-sharing rules continue to apply.
Are ACOs available only through Medicare?
No. Accountable care arrangements also exist outside Medicare, including among commercial payers and provider systems. The governing contract and participation details differ.
How can I find out whether my doctor is in an ACO?
Ask the practice directly. If you have Original Medicare, you may also receive information about a clinician's participation in a Medicare ACO.
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Sources and further reading
Government resources explain ACOs, their goals, and the rights of patients with Original Medicare.
Definition and purpose of an accountable care organization.
Federal explanation of provider accountability and coordinated care.
Program overview, performance and cost considerations.
Patient rights and how ACOs coordinate care for people with Original Medicare.