Medicare Accountable Care Organization (ACO) frequently asked questions
Background about Mayo Clinic and Mayo Clinic Health System's participation in a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO)
Mayo Clinic and Mayo Clinic Health System were accepted by Centers for Medicare & Medicaid Services (CMS) to participate in an MSSP ACO. The Mayo Clinic Community ACO, LLC, started July 1, 2019.
What is the MSSP?
The MSSP provides alternative ways for health care organizations to be paid for their services based on performance in quality, cost and patient experience. An ACO is one type of shared savings program that allows health care providers to work together to provide high-quality, cost-effective, coordinated care to patients.
What is an ACO?
- An ACO is a group of health care providers who take responsibility for the total cost and quality of care for their patients, and in exchange they can receive a portion of the savings they achieve.
- An ACO agrees to work together with Medicare to give patients the best possible care.
- ACOs have agreements with Medicare to be financially accountable for the quality, cost and experience of care that traditional fee-for-service Medicare patients receive.
- According to ACO program guidance and specifications, participating in an ACO may involve earned shared savings payments or incurred losses.
- ACOs are rewarded when they lower growth in Medicare Parts A and B expenditures (relative to their benchmark) while meeting quality performance standards.
- During the time frame of the shared-risk arrangement of the program,ACOs must repay CMS for shared losses, if they are incurred.
Which Mayo Clinic and Mayo Clinic Health System providers and sites are participating in the ACO?
The Mayo Clinic Community ACO includes Mayo Clinic's Rochester, Minnesota, campus and all Mayo Clinic Health System locations in Minnesota and Wisconsin.
Why are Mayo Clinic and Mayo Clinic Health System participating in a Medicare ACO?
- Mayo Clinic and Mayo Clinic Health System were well prepared to participate in an ACO. Value-based practice transformation efforts have already been taking place in primary care and specialty care, and the ACO initiatives align with our hallmarks of multidisciplinary, team-based and integrated care. For example, Mayo Clinic and Mayo Clinic Health System already function as an integrated health care organization. One electronic health record, Epic, has further increased our integration and collaboration.
- Participating in an ACO will allow Mayo Clinic and Mayo Clinic Health System to prepare for the industrywide shift toward pay for value and to improve Medicare sustainability.
How does the ACO benefit patients?
- The ACO program is designed to improve quality of care for a whole population of Medicare fee-for-service patients.
- The data Medicare shares with Mayo Clinic Community ACO is used to inform us about the health needs of our Medicare fee-for-service population as a whole.
- Information obtained from Medicare about quality, cost of care and patient experience will be used to enhance Mayo Clinic Community ACO's care delivery tools and processes and continue to improve our high-quality care at Mayo Clinic and Mayo Clinic Health System.
How does the ACO benefit me as a patient if I only see one provider?
- Some patients see providers or go to hospitals outside of Mayo Clinic and Mayo Clinic Health System. Some patients only see providers and go to hospitals at Mayo Clinic or Mayo Clinic Health System. If you are a patient who only sees providers at Mayo Clinic or Mayo Clinic Health System, we already have all of your information in our electronic health record.
- Even though we won't get any new information from Medicare about you, we will still be working to improve the quality and experience of care you receive.
What information is Medicare sharing with Mayo Clinic Community ACO?
- The data that Medicare shares with the ACO is information that is from Medicare claims data, which is your Medicare billing information. For instance, the data may show that you had an X-ray or lab test, but it will not show the results of those tests. It will show the test name, date and location where the test was performed.
- The claims data from Medicare includes is for all providers, hospitals and clinics where you have been seen.
- The Medicare data informs Mayo Clinic Community ACO that patients have seen other providers, but it provides limited information.
- The data informs Mayo Clinic Community ACO about the health needs of our Medicare fee-for-service population as a whole.
Will Medicare be able to see my medical record?
Medicare cannot see the health records (also known as electronic medical records) for Mayo Clinic and Mayo Clinic Health System or Mayo Clinic Community ACO.
Will the data that Medicare shares with Mayo Clinic Community ACO be kept private?
- Yes, your privacy is important to both Mayo Clinic Community ACO and Medicare, and extensive systems and processes are in place to ensure the shared data is handled in a confidential manner.
- Medicare shares the data with Mayo Clinic Community ACO through a very secure transmission process.
- Mayo Clinic Community ACO is committed to protecting patients' privacy and maintaining confidentiality.
What if I don't want to share my health information with the ACO?
- If you do not want Medicare to share your health care information with the Mayo Clinic Community ACO, you must call 800 MEDICARE (800-633-4227). Tell the representative:
- Your provider is part of an ACO and you don't want Medicare to share your health care information.
- Mayo Clinic Community ACO started July 1, 2019.
- Mayo Clinic Community ACO's identification number is A4617.
If I decline to share my Medicare data, will my providers at Mayo Clinic and Mayo Clinic Health System still be able to see my medical information?
- Mayo Clinic and Mayo Clinic Health System providers will still see your medical information about care that you receive at our sites. This data is stored in the Mayo Clinic and Mayo Clinic Health System electronic health record (EHR), also known as a medical record.
- Medicare does not have access to Mayo Clinic and Mayo Clinic Health System's electronic health records.
- If you decline to share your data, this means that the Mayo Clinic Community ACO will not receive the claims data from Medicare about your care.
- If you receive care from non-Mayo providers, you may sign an authorization for release of information to share that information with Mayo Clinic and Mayo Clinic Health System. Thus, Mayo Clinic and Mayo Clinic Health System may receive some of your health information directly from those providers, at your request.
If I decline to share my health care information, am I out of the ACO?
- If you decline to share your Medicare claims data with the Mayo Clinic Community ACO, you are still a Mayo Clinic or Mayo Clinic Health System patient and there will be no change to your provider or care based on your decision.
- According to Medicare, "Even if you decline to share your health care information, Medicare will still use your information for some purposes, like assessing the financial and quality of care performance of the health care providers participating in ACOs. Also, Medicare may share some of your health care information with ACOs when measuring the quality of care given by health care providers participating in those ACOs."
- This means that Medicare will not share specific information about you as a patient, but will continue to share information about how Mayo Clinic Community ACO is performing regarding financials and quality of care for Medicare fee-for-service beneficiaries.
- The Mayo Clinic Community ACO is an agreement between Medicare and Mayo Clinic and Mayo Clinic Health System. Thus, Mayo Clinic and Mayo Clinic Health System are the participants in the ACO and are held accountable for the quality and experience of care.
Are my health care benefits changing?
- Your Medicare benefits are not changing. Your health coverage, premiums and insurance arrangements are not affected.
- Our participation in the Mayo Clinic Community Accountable Care Organization (ACO) doesn't limit your choice of health care providers. You still have the right to visit any doctor, hospital or other provider that accepts Medicare at any time, just like you do now.
Is the ACO a Medicare Advantage Plan or an HMO?
An ACO isn't a Medicare Advantage Plan, a health maintenance organization (HMO) plan or an insurance plan of any kind. It is an agreement between Mayo Clinic Community ACO and Medicare to be financially accountable for the quality, cost and experience of care you receive.
Can I keep my provider? The language in the beneficiary notice makes it sound like that might change: "We may recommend that you see particular doctors for your specific health needs, but it's always your choice about what doctors you use or hospitals you visit."
- Your provider (and access to your provider) will not change as a result of Mayo Clinic and Mayo Clinic Health System's participation in an ACO.
- As Medicare states, you still have the right to visit any doctor, hospital or other provider that accepts Medicare at any time, just like you do now.
- We may make a recommendation about providers for a couple of reasons:
- To ensure that you have a main doctor where you live (primary care provider).
- If you need to see a specialist, we may recommend a specialist for you to see, but "it's always your choice about what doctors you use or hospitals you visit," as Medicare states.
I am an executive health patient. Will my care change?
Mayo Clinic and Mayo Clinic Health System's participation in an ACO will not impact the Executive Health Program's care delivery.
I am a Mayo Clinic or Mayo Clinic Health System retired employee. Will the ACO impact my supplemental insurance?
Mayo Clinic and Mayo Clinic Health System's participation in an ACO will not impact your retiree, supplemental insurance. Mayo Clinic Community ACO will not change any Medicare benefits or other insurance benefits or your access to medical care.
What is evidence-based medicine and how will it impact my care?
- Evidence-based medicine is the standard of care that is recommended for all patients. This is considered to be the best practice of care. All Mayo Clinic Community ACO doctors have access to an internal tool named AskMayoExpert, which is a resource for practicing evidence-based medicine.
- AskMayoExpert is a best practice information resource that covers more than 1,600 topics and provides access to Mayo expertise.
- All content in AskMayoExpert is written and vetted by Mayo Clinic and Mayo Clinic Health System providers. In addition, subject matter experts are listed for specific topics to aid providers in consulting with experts.
Will my future care be restricted due to cost restraints?
No. Reductions in costs of care will be achieved by not repeating tests, improving the coordination of your care, and improving preventive care and wellness.
Avoiding unnecessary tests is mentioned in the beneficiary notification. Does that mean I won't be able to get medical tests?
- Mayo Clinic and Mayo Clinic Health System's participation in an ACO will not keep you from receiving tests when you need them.
- "Unnecessary" means not repeating (duplicating) tests or procedures you have already received.
- It may also mean having a conversation with your provider to determine if, and when, you should have a test or which test(s) you should have or avoid.
Mayo Clinic and Mayo Clinic Health System did not participate in an ACO previously. Why did Mayo change positions about joining an ACO?
- Mayo Clinic and Mayo Clinic Health System's primary value is and remains "the needs of the patient come first."
- The Medicare Shared Savings Program that oversees the Accountable Care Organization program has evolved over the years since it started in 2012.
- The current Medicare Shared Savings Program is focused on patient-centered outcomes and lowering costs. It aligns better with Mayo Clinic and Mayo Clinic Health System's values and approach to patient-centered and coordinated care.
What if I have other questions?
If you have questions about Mayo Clinic and Mayo Clinic Health System's participation in the Mayo Clinic Community ACO, you may contact us.
- Phone: 833-236-0314 (toll-free) or 507-422-6244
- Email: MedicareACO@mayo.edu
If you have question about Medicare, please contact Medicare directly.
- Phone: 800-MEDICARE (800-633-4227)
- TTY/TDD: 877-486-2048
If you have specific questions about your health care at Mayo Clinic or Mayo Clinic Health System.
- Contact your local primary care provider or care team.
If you have questions or comments about your patient experience with Mayo Clinic Community ACO, you may contact the Office of Patient Experience for your area:
- Rochester, Minnesota, campus
- Phone: 507-284-4988
- Email: firstname.lastname@example.org
- Mayo Clinic Health System (Minnesota, Wisconsin and Iowa locations)
- Phone: 844-544-0036
- Email: MCHSOPE@mayo.edu
- Arizona, Scottsdale or Phoenix campus
- Phone: 480-342-2651
- Email: ARZOPE@mayo.edu
- Florida, Jacksonville campus
- Phone: 904-953-2019
- Email: FLAOFFPATEXP@mayo.edu