A Patient’s Guide to Accountable Care Organizations

Did you get a letter saying your provider is part of a Medicare Shared Savings Program accountable care organization? You may be wondering what that means for you. Wood County Hospital mails these letters because Medicare requires it. The wording comes straight from the Centers for Medicare & Medicaid Services (CMS), the federal agency that runs Medicare, which is why it can read like a legal notice.

Here’s the short answer: the letter itself needs no response. Your Medicare coverage, your provider and your costs all stay the same. This guide explains what an accountable care organization is, what it means for your care at Wood County Hospital and who to call with questions.

What Is an Accountable Care Organization?

An accountable care organization, or ACO, is a group of doctors, hospitals and other health care providers who agree to work as one team for their Medicare patients. They share information about your care, so everyone treating you can see what the others have already done. The Medicare Shared Savings Program is the federal program that sets up these groups. Providers at Wood Health Company and Women's Care of Wood County are part of one, which is why patients with traditional Medicare, also called original Medicare, get a notice in the mail.

An ACO is not an insurance plan. It's simply a way for the people who care for you to work together. There is nothing to join and nothing to sign up for. You keep the same Medicare coverage, the same doctor and the same out-of-pocket costs.

"Nothing changes for our patients," said Jennifer Lammers, an RN and Director of Population Health at Wood Health Company. "We provide the same care to everybody."

What does change is how information moves behind the scenes. Your primary care provider, your specialists and the doctors who treat you in the hospital can all see a fuller picture of your care. For you, that means fewer gaps, fewer surprises and fewer mistakes in your records between visits.

What Being Part of an ACO Means for Your Care

Most of this teamwork happens behind the scenes. Here are the parts you are most likely to notice:

Your care team stays on the same page: Your primary care office, your specialists and the hospital can all see which tests, referrals and follow-ups are finished and which ones are still open. You spend less time repeating your history at every visit.

Fewer repeat tests: When your providers can see results from another office, you are less likely to sit through a lab test or scan you already had. That saves you time, travel and money.

Safer medications: When every provider sees the same list of your prescriptions, it is easier to catch a drug interaction or a double dose. This matters most right after a prescription changes, because a new medicine can bring on symptoms patients don't expect.

A nurse checks in with you after a hospital stay: Wood County Hospital has two registered nurse care managers who call Medicare patients after an emergency room visit, a hospital stay or a stay in a skilled nursing facility, such as a rehab or nursing home. They make sure your discharge instructions make sense to you, your medication changes are clear and your follow-up appointment is scheduled with the right provider.

That last one solves a problem Lammers says is easy to underestimate.

"As a nurse, I have looked at my own parents' discharge instructions and been confused by them," she said. "You wonder what to do with 20 pages of paperwork when what you needed was two paragraphs."

Wood County Hospital offers these care managers at no cost. They work by phone, so you don't need to come in for another appointment. If it's easier, they will talk with your spouse, an adult child or another caregiver who helps with your care.

Wood County Hospital also has a licensed social worker who works side by side with the primary care team, which Lammers says is uncommon among similar organizations. The social worker can connect you with local resources, point out insurance benefits you may not know you have and help you put your wishes for future care in writing.

"If someone needs a living will or a health care power of attorney, our social worker can walk them through it," Lammers said. "We don’t bill for those services.”

Proactive Care and Screenings Through Your ACO

Being part of the Shared Savings Program means Wood County Hospital reports to Medicare each year on how well it keeps patients healthy. Medicare calls these quality measures. Recent measures include breast cancer screening, colorectal cancer screening, blood sugar control for patients with diabetes, blood pressure control for patients with high blood pressure and depression screening with follow-up care.

For you, those measures are the reason you may get a reminder about a mammogram or a call to schedule your annual wellness visit. It isn't a sales pitch. It's how your care team keeps you informed of what screenings and appointments you may need to stay healthy. Your yearly Medicare Annual Wellness Visit is free, and Medicare also covers recommended colorectal and breast cancer screenings, usually at no cost to you.

One detail surprises many patients: this extra attention isn’t only for people with Medicare.

"Even though this is a traditional Medicare program, what they ask us to do for those patients, we do for all patients and all payers," Lammers said.

In plain terms, the reminders, screenings and follow-up calls go to Wood County Hospital patients with any kind of insurance, not just those with Medicare. The reporting also goes beyond whether a test was done. For blood sugar, blood pressure and depression screening, Wood County Hospital reports the actual results. So the goal isn't just checking a box. It's making sure your condition is truly under control.

Your Data and Privacy

The official Medicare notice that comes with the letter explains how your health information is shared inside an ACO and gives you the choice to opt out of part of it. Here's what that means. Medicare may share your claims history with the ACO. Your claims history is the record of appointments, tests and treatments Medicare has paid for. It lets your care team see care you received somewhere else, even from a provider outside Wood County Hospital.

That sharing is what makes coordinated care possible. Even so, you can say no. If you opt out, your coverage, your care and your relationship with your doctor stay exactly the same. You can also ask for written proof that you opted out. To opt out or ask a question, call Wood County Hospital's Director of Population Health at 419-373-7639, or call Medicare directly at 1-800-MEDICARE. TTY users can call 1-877-486-2048.

Do You Need to Do Anything?

No. The letter is just a required notice. There's nothing to sign, return or decide and no deadline to worry about. One thing is worth acting on, though. If your letter says you are due for a cancer screening or your free Annual Wellness Visit, call your primary care team to get it scheduled. For anything else, bring the letter to your next appointment or call the number listed above.

A few questions come up often:

Will this change my doctor? No. You continue to see the same provider.

Will it cost me anything? No. Participation doesn’t change what Medicare covers or what you pay.

Is this the same as Medicare Advantage? No. Medicare Advantage is a private insurance plan that takes the place of original Medicare. An ACO is not a plan at all. It's a group of providers working together, and you keep the Medicare coverage you have now.

Do I need to enroll? No. There’s no sign-up step for patients and nothing to fill out.

Will my Medicare benefits change? No. Your benefits remain the same.

Your Care is Still in Good Hands at Wood County Hospital

A letter written in federal program language can be unsettling, especially when it shows up without warning. If your letter left you with questions, call your primary care office. They can explain what it means for you, and the answer is usually simple: your care team is working together so less falls through the cracks.

The point is to catch problems early, before they turn into a hospital stay. As Lammers put it, "Let us help you before you get that sick."

You can also call any Wood County Hospital office or send your question online through our Contact Us page.