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Rural Health Information Hub

ACO Model Implementation Considerations

There are several important considerations with forming an accountable care organization (ACO) for rural care coordination.

Cost: The costs associated with forming an ACO may present challenges for some small and medium sized rural physician practices that have more limited access to capital and infrastructure. Participating in an ACO may benefit rural providers through shared savings. The shared savings can be reinvested, for example, to finance care coordination activities or modernize data infrastructure.

Antitrust laws and minimum beneficiary requirements: These should be considered when forming an ACO. Because some ACOs participate in both Medicare and commercial markets, the Federal Trade Commission and Department of Justice developed a policy statement to guide provider organizations in developing ACOs that comply with federal antitrust laws.

Medicare market: It is important to consider the Medicare market in the rural community. Some rural ACOs have a minimum number of Medicare beneficiaries, which may be difficult for frontier communities to maintain. ACOs may face challenges if providers leave the ACO and, as a result, the number of beneficiaries falls below the minimum.

Data sharing: Obtaining permission to share data between healthcare organizations and across state lines can also be a challenge for rural ACOs. It is important to establish formal agreements for data sharing.

Resources to Learn More

Accountable Care Organizations
Provides information and resources regarding the ACO Antitrust Enforcement Policy Statement, including the Federal Register Notice, a summary of activities following the issuance of the policy, and answers to frequently asked questions.
Organization(s): Federal Trade Commission

Accountable Care Organizations in Rural America
This rural policy brief presents data collected from Medicare ACOs regarding their presence in metropolitan and non-metropolitan counties.
Organization(s): RUPRI Center for Rural Health Policy Analysis
Date: 7/2013