Medicare allots a yearly budget for each beneficiary. The amount the person is allotted is dependent on their age, chronic illnesses, and any disabilities that they may have. When a Medicare beneficiary receives treatment from an ACO affiliated physician, it is the ACO’s duty to compile the beneficiary’s history, budget, and current data and then create a care plan that will help the patient and save Medicare money.
Example of Medicare expectations:
A 70 year old man with diabetes and a missing leg is paying for Medicare insurance. Medicare takes into account his age and illness and predicts that the yearly cost to care for him would be around $15,000. The 70 year old man’s primary care physician is part of an ACO. In order for the ACO to receive money from Medicare for cutting their expenses, Medicare expects the ACO to save at least 3% of the patient’s yearly budget.
When analyzing data, some ACOs do it themselves and some ACOs hire analytics companies, such as Synergy Infoconnect, to do it for them. Analyzing patient care data is important because it tells the ACO how well they are doing with their care plans and how much money they are saving on a patient-by-patient basis. As the year progresses, the ACO can refine each of their care plans and save more money. This could be through preventative care, such as weekly check-ups. This allows the doctors or nurses to see how the chronic illness is progressing, and what they can do to treat it or slow it down. By doing this, doctors are able to treat the patient early if they notice symptoms of a bigger illness, and are able to keep the beneficiaries out of the hospital and with their families.