HealthChoice is an Accountable Care Organization (ACO)

HealthChoice works together with physicians, hospitals, dialysis centers and other healthcare providers to form a network of providers, called an Accountable Care Organization (ACO), with the goal of giving you better care at a lower cost. 

What is an ACO?

• The aim of an ACO is to improve the quality of your care in the most cost-effective manner.
• The ACOs receive incentives for giving you better care at a lower cost. 
• Providers who join an ACO and are able to save money, share in the savings with Healthcare plans or the Medicare program.
• If our network of providers is able to save money AND meet quality standards, they can share in savings.  We are graded on the quality of care you receive.  If quality standards are not met, any shared savings may be reduced or eliminated.

How are ACOs different?

• ACOs are NOT a health insurance plan.
  • You still receive your health benefits from your employer’s group health plan or your Original Medicare plan.
  • You do not sign up or join an ACO.
  • Your providers will work together to share information about your care to avoid unnecessary repeated tests and to better coordinate your care.
  • Your care may be coordinated by your provider directly and/or by the HealthChoice care management team of Nurse Care Managers and Medical Assistants.

Who can get care from an ACO?

• Anyone with an employer group health plan or Original Medicare may receive care from an ACO provider.
  • If your doctor is in an ACO, then you are automatically part of the ACO, and you do not have to join or enroll.
  • If you are in a Medicare Advantage plan, you cannot be in an ACO.

How do I know if I am getting care from an ACO provider?

• You can always ask your doctor or the staff if they are in an ACO.
• There may be a notice in your doctor’s office about the HealthChoice ACO.
• You may get a letter or notice from HealthChoice, your doctor or from Medicare letting you know your doctor is in an ACO.

What differences will I see if my doctor is in an ACO?

• You may notice that your doctor may have a non-physician team member help you with coordinating care.
• You may receive phone calls from the HealthChoice Nurse Care Managers to check on you after your visit to the Emergency Room or after you discharge from the hospital.  They may review your discharge plan, provide education about your medications or your condition, or just a check-in call to make sure you are OK and if you have any discharge needs.
• You may receive reminders to get needed screenings or tests, to get your Annual Well Visit or Annual Physical, and even reminders on where to get the care you need for your illness or condition. 
• You may notice that all your physicians are talking with each other, so you do not have to fill out so many forms repeating your information, and you should not have unnecessary duplicate tests or procedures.

Do I still have a choice of providers?

• Yes.  You can still see any doctor or hospital that accepts your employer group health plan or Original Medicare.  You do not have to choose ACO providers, unless your employer group health plan has a specific narrow network based on your benefit plan.

Can I opt out of the ACO?

• No.  As long as you are receiving most of your care form a provider in an ACO, you are considered to be in the ACO.  If you choose a provider who is not in the ACO, and you get most of your care from that provider, then you won’t be in the ACO.

Can I opt out of having my health insurance shared with an ACO?

• Yes.  If you do not want CMS to share your information with the ACO, you can contact CMS at 1-800-MEDICARE and ask to opt out of data sharing. Your doctors will continue to share information as part of your care to make sure you get the best possible medical care.