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Mercy ACO Frequently Asked Questions

WHAT IS MERCY ACO?

Mercy ACO is made up of a team of health care providers working together to coordinate patient care. The ACO combines the entire range of patient care-primary doctor, specialists, hospitals, home health services, etc.-in an effort to realize greater efficiencies and lower the out-of-pocket costs for patients.

WHAT IS COORDINATED CARE?

Coordinated care is a term used to describe patient care in the new health care delivery model. In an ACO, coordinated care includes:

  • Increased communication among primary care and specialty providers who work together and share vital information to plan the best possible patient care;

  • Health care providers who can anticipate patient needs and begin treatment before serious complications occur;

  • A decrease in the potential for duplicated and/or unnecessary testing or services;

  • The development of new programs and services aimed at keeping healthy people healthy and helping those with chronic illnesses manage their own care;

  •  Increased communication between health care providers and patients; and

  • An overall improvement in health care services and better outcomes.

HOW WILL ACOS BENEFIT PATIENTS?

The ACO model is beneficial for all patients, regardless of their health care needs.  Patients with chronic illnesses, such as diabetes, high blood pressure and high cholesterol, will find value in the ACO through better health management and personalized treatment plans.  Healthy patients will notice an increased emphasis on maintaining a healthy lifestyle and recommendations for appropriate screenings and regular preventive care.  As a result, patients can expect to reduce their risk for serious health complications and will enjoy better health.

How is the ACO model different from an HMO?

The ACO model is different from other managed care plans you may be familiar with in the past. Health Maintenance Organizations (HMOs), popular in the 1990s, were designed to strictly manage services and costs. HMOs required participants to have a primary care physician and required you to have a PCP referral before seeing a specialist. The ACO model does not require referrals for specialists. The goal of an HMO was to limit services; an ACO model considers your whole health to ensure you get the right care for the right reasons.

How can patients take advantage of ACO benefits?

The ACO will be most successful when patients consistently receive care from the same physician within the same clinical setting. In the ACO model, patients are able to choose the doctor(s) from whom they wish to receive care, however, patients are encouraged to select a primary care physician to visit regularly for all health care needs. 

Coordinating care through one provider or a centralized location-sometimes referred to as a medical home-allows patient data to be stored in one place where all physicians providing care to patients can access vital information quickly. This method helps to assure patients receive the right treatment at the right time even if their regular primary care provider is not available.

How will an ACO get me healthy and/or keep me healthy?

A key component of Mercy ACO is the health coach program.  Mercy health coaches are licensed, registered nurses stationed within the Mercy primary care clinics. Health coaches work in conjunction with primary care physicians to provide personalized, one-on-one care to help patients set and achieve their health care improvement goals.

Health coaches are responsible for following up with patients who may be at higher risk for developing chronic illnesses and will also work with healthy patients to provide reminders for regular health care screenings.

 

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