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Supporting Patients

Your Community Health Center is a proud participant of a Medicare Accountable Care Organization

  • What is an Accountable Care Organization?
    Accountable Care Organizations are groups of health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. For patients, this means providers can do more to follow their health, make sure they get the best possible care, and may hire additional staff to help meet patients unique care needs.
  • Why do providers choose to participate in an Accountable Care Organization?
    Providers choose to participate in an Accountable Care Organization because they are committed to providing patients with a better care experience. An ACO is not the same as a Medicare Advantage Plan or Health Maintenance Organization. Patients are still in Original Medicare, and their Medicare benefits, services, rights, and protections won’t change. They continue to have the right to use any provider or hospital that accepts Medicare at any time.
  • How does participating in an Accountable Care Organization help providers?
    Providers in Accountable Care Organizations may have better access to the expertise, staff, and technology they need to make sure care is coordinated across all the places patients receive services. This coordination could mean less paperwork to fill out at the provider’s office, avoiding unnecessary tests, or more help in dealing with any health conditions.
  • How do I know if a provider is participating in an Accountable Care Organization?
    A listing of Health Choice Care’s participating providers can be found here. Patients can reach out to their provider’s office or contact Health Choice Care directly at 305-471-8770 with any additional questions.
  • When a patient is notified that their provider is in an Accountable Care Organization, what do they need to do?
    No action is required. Even though a provider is participating in an ACO, a patients Medicare benefits will not change. They will still be in Original Medicare, and they will still have the right to use any provider or hospital that accepts Medicare, at any time.
  • Do patients participate in an Accountable Care Organization if their provider does?
    Only the provider participates in an Accountable Care Organization. Patients do not participate in the ACO, they just receive the benefits. Patients still have the right to see any provider or hospital that accepts Medicare, at any time. Patients can continue getting care from their provider or they can choose to see a provider that does not participate in an ACO.
  • Can a patient still see all their regular Medicare providers and healthcare providers even though their provider participates in an Accountable Care Organization?
    Yes. It’s important to know that: · Patients can still go to any provider, hospital, or other provider that accepts Medicare. Nobody can restrict which providers they see. · Patients are still in Original Medicare. · Patients are still entitled to all the same Medicare services, benefits, and protections.
  • What patient information will the Accountable Care Organization have access to?
    To help providers who participate in an Accountable Care Organization give patients the best possible care, Medicare wants to share some additional information about patients care with them. This information includes things like provider, hospital, and pharmacy visits in the past and moving forward. This information helps to make sure the provider knows about the services patients have already received, understand where they may need more care, and find ways to smooth the path for patients if they must transfer in or out of a hospital, or from the care of one provider to another. If a patient decides they do not want to have their information shared with the ACO, they can elect not to. It is important to note that Medicare will not share any information about a patient’s alcohol and drug treatment history unless they choose to share it and indicate that in writing.
  • How can patients decline the sharing of their personal health information with the Accountable Care Organization?
    Patients can prevent Medicare from sharing their information to the ACO at any time. They can call 1-800 MEDICARE (1-800-633-4227) and tell the operator they are calling about Accountable Care Organizations and would like to decline data sharing. TTY users should call 1-877-486-2048. Medicare will update its records to show that the patient does not want to have their data shared. It will take about 45 days for this change to take effect.
  • Can a patient change their mind and decide that they do want their personal health information shared in the future?
    Yes. If the patient changes their mind in the future, they can call 1-800 Medicare (1-800-633-4227) and tell them that they have changed their mind and that they do want their data shared with the Accountable Care Organization.
  • Is an Accountable Care Organization a Medicare Advantage Plan or an HMO?
    An ACO is not a Medicare Advantage Plan, a health maintenance organization plan, or an insurance plan of any kind. It is an agreement between your health care provider and Medicare to be financially accountable for the quality, cost, and experience of care you received.
  • How do Accountable Care Organizations share information?
    Providers use data from Medicare to help improve how they provide care. The ACO will share patients’ medical information, such as medical conditions and prescriptions, to the patient’s provider. This aids the provider in managing the patients care and ensures patients receive the right care at the right time in the right setting.

The Benefits of Seeing a Provider that Participates in an ACO

Comprehensive Patient Care

Continuity of Care

Care Coordinator

Compliance violations and concerns should be reported:​

  •  ACO Compliance Officer, Meredith Marsh, 305-205-2935​

  •  ACO Compliance and Ethics Hotline (Anonymous): 305-471-8775 ​

  • Compliance Mailbox:  HCNCompliance@hcnetwork.org   ​

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What will happen when I report a violation:​

  • All reported matters will be documented and investigated in accordance with Compliance and Integrity Program policies and procedures.​

  • If known and if appropriate, you may be advised as to the disposition of the reported matter.​

  • It is Health Choice Care’s policy that there will be no retaliation for asking questions or raising concerns about the standards or for reporting possible improper conduct.

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Reporting Fraud, Waste, and Abuse to OIG/CMS/DOJ:​

  • HHS Office of Inspector General (OIG): ​

·   Instructions: Reporting Fraud to OIG - YouTube​

·   Phone: 1-800-HHS-TIPS (1-800-447-8477) or TTY 1-800-377-4950 ​

·   Fax: 1-800-HHS-TIPS (800-223-8164) ​

·   Email: HHSTips@oig.hhs.gov ​

·   Online: https://oig.hhs.gov/fraud/report-fraud/index.asp​

  • HHS and U.S. Department of Justice (DOJ):​

·   Online https://www.justice.gov/archives/opa/blog/stop-medicare-fraud

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