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An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation. The organization is accountable to ...
HCFA was renamed the Centers for Medicare and Medicaid Services on July 1, 2001. [9] [11] In 2013, a report by the inspector general found that CMS had paid $23 million in benefits to deceased beneficiaries in 2011. [12] In April 2014, CMS released raw claims data from 2012 that gave a look into what types of doctors billed Medicare the most. [13]
The Center for Medicare and Medicaid Innovation (CMMI; also known as the CMS Innovation Center) is an organization of the United States government under the Centers for Medicare and Medicaid Services (CMS). [1] It was created by the Patient Protection and Affordable Care Act, the 2010 U.S. health care reform legislation.
An incentive for many health plans to collect HEDIS data is a Centers for Medicare and Medicaid Services (CMS) requirement that health maintenance organizations (HMOs) submit Medicare HEDIS data in order to provide HMO services for Medicare enrollees under a program called Medicare Advantage.
ACOs are indeed an evolved approach after consumer backlash with HMOs in the 90s. ACOs differ from HMOs in two key ways: specifically for Medicare ACOs patient provider choice is not limited (as opposed to an managed care network); also in ACOs reimbursement/profit may be held from providers if quality benchmarks are not met or improved on.
As participation in value-based reimbursement models such as accountable care organizations (ACOs) increases, these initiatives will help drive population health. [24] Within the ACO model, hospitals have to meet specific quality benchmarks, focus on prevention, and carefully manage patients with chronic diseases. [25]
Its members are part of the Medicaid segment of the population and the CCO works with health care providers, hospitals, and local community groups to integrate healthcare services and contain cost increases through improved quality of care. [1] [2] CCOs were created through Oregon Senate Bill 1580. [3]
It was created as a result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, established seven zones throughout the United States to process Medicare claims, CMS created ZPICs to more effectively protect the Medicare program. [2]