QUESTIONS ABOUT MEDICARE ADVANTAGE PLANS?
If you are Medicare eligible and would like to learn about the added benefits and care coordination that Medicare Advantage insurance plans can provide, click Learn More below.
AppleCare Medical Group is now a Medicare Shared Saving Plan (MSSP) ACO.
In September 2012, AppleCare Medical Group was approved by Medicare to become a Medicare Shared Saving Plan (MSSP) ACO.
ACO refers to a group of providers and suppliers of services (e.g. hospitals, physicians, and others involved in patient care) that will work together to coordinate care for the Medicare Fee-For-Service patients they serve. The goal of an ACO is to deliver seamless, high-quality care for Medicare beneficiaries, instead of the fragmented care that often results from a Fee-For-Service payment system in which different providers receive different, disconnected payments. The ACO is a patient-centered organization where the patient and providers are true partners in a care decision.
ACO is not an insurance, patients are Medicare Fee-For-Service, not capitated. They do not require authorizations to be seen and services will still be paid by Medicare.
To participate in the AppleCare Medical Group ACO, providers can contact Network Management at (714) 443-4510 to discuss joining our ACO.
CMS will measure quality of care using nationally recognized measures in four key domains: patient experience, care coordination/patient safety, preventive health, and at-risk population. These measures are aligned with the measure in other CMS programs such as the Electronic Health Record (EHR) and Physician Quality Reporting System (PQRS).
Health care providers have reported that a barrier to improving care coordination is lack of information. While they may know about the services they provide to the beneficiary, they don’t know about all other services provided to the beneficiary. To better treat patients and to coordinate their care, ACOs will be able to request Medicare claims information about their patient from CMS. (Before doing so, ACOs must notify a beneficiary in writing that it will request having their claims information shared. Beneficiaries can decline to share their information.)