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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
Website
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
Document
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

The Rural Advantage
Document
This article discusses the challenges and opportunities for rural entities seeking to form an ACO and includes the example of Eastern Maine Healthcare Systems (EMHS), which implemented a Pioneer ACO Model.
Organization(s): Health Forum
Date: 1/2013

Rural Hospital Participation in Accountable Care Organizations (ACOs) and Patient-Centered Medical Care Homes
Video/Multimedia
Provides links to a webinar and presentation slides that describe the goals of ACOs, activities conducted by the Rural Health System Analysis and Technical Assistance projects, and the implementation activities of a rural ACO.
Organization(s): National Rural Health Resource Center
Date: 5/2013