Frequently asked questions

What is a Care Coordinator?

A Care Coordinator manages and coordinates care for an Accountable Care Organization's (ACO) beneficiaries and patients of St. Joseph providers. The Care Coordinator assists with the development of individual patient care plans. By identifying and closing gaps in the care of patients through the facilitation of appointments, monitoring referrals, and solving other issues that may affect a patient's ability to receive care, such as transportation difficulties, tracking investigations, and managing medications.

A Care Coordinator also provides patient education regarding preventative and urgent care, palliative care, hospice, and medication adherence. Coordinators ensure the delivery of quality, effective and cost-efficient healthcare services to patients by collaborating with primary care providers, specialists, and other members of the Care Coordination Team.

What is Clinical Integration?

Clinical Integration is a physician-led, clinically integrated network of providers who evaluate and modify the practice patterns of all physician participants. The goal is to create a high degree of interdependence and cooperation among physicians in order to control costs and ensure quality.

What is an ACO?

An Accountable Care Organization (ACO) is a group of doctors and other healthcare providers who agree to work together with Medicare to give you the best possible care.

The goal of the ACO is to support your doctor in caring for you by making sure they have the most up-to-date information about your health and your care. For you, this means your doctors communicate better with each other, and you avoid having duplicate tests, or answering the same questions over and over.

ACOs may take different approaches to giving you coordinated care. Some ACOs may have special nurses that help you set up appointments, or make sure your medications are in order when you enter or leave a hospital. Other ACOs may help your doctors get equipment for you to monitor your medical conditions better at home, if needed. Most ACOs use advanced systems that let them more carefully coordinate your care.

Doctors and other healthcare providers choose to participate in an ACO because they're committed to providing you with a better care experience. They may also be rewarded for offering you better, more coordinated care. If your doctor chooses to participate in an ACO, you will be notified, either in person or by letter.

An ACO isn't the same as a Medicare Advantage Plan or Health Maintenance Organization (HMO). You're still in original Medicare, and your Medicare benefits, services, rights and protections won't change. You still have the right to use any doctor or hospital that accepts Medicare at any time, the same way you do now.

How do I know if my provider is in an ACO?

If your provider is participating in an ACO, you will be notified, either in person or by letter.

If I have not been notified that my provider is in an ACO, what do I need to do?

You don't need to do anything right now. Even if your provider is participating in an ACO, your Medicare benefits won't change. You'll still be in original Medicare, and you'll still have the right to use any doctor or hospital that accepts Medicare, at any time.

Do I have to participate in an ACO since my provider is participating?

Only your doctor, in this case, your provider, participates in an Accountable Care Organization (ACO). As his/her patient, you do not participate in the ACO. You still have the right to see any doctor or hospital that accepts Medicare, at any time. You can continue getting care from your provider. Or, you can choose to see a doctor who doesn't participate in an ACO.

Can I still see all of my regular Medicare doctors and healthcare providers even though my provider participates in an ACO?

Yes. It's important to know that:

You can still go to any doctor, hospital, or other provider that accepts Medicare – nobody can restrict which providers you see You are still in original MedicareYou are still entitled to all the same Medicare services, benefits, and protections.

Can I still choose to receive services from any new doctor, hospital or healthcare provider that I want to, even though my provider is participating in an ACO?

You can still choose to go to any doctor, hospital, or other healthcare provider that accepts Medicare. Nobody –not even your provider –can prevent you from seeing the doctors, hospitals or providers you want.

What information about me will the ACO have access to?

To help doctors who participate in an ACO give patients the best possible care, Medicare wants to share with them additional information about your care. Information shared may include your doctor, hospital, and pharmacy visits in the past, and moving forward. This information helps your provider, and the other ACO providers track the services you've already received, understand where you may need more care, and find ways to smooth the path for you if you have to transfer in or out of a hospital, or from the care of one doctor to another. If you decide you do not want to have the information about your care shared with the ACO, you can decline to do so.

How can I decline to have my personal health information shared?

We value your privacy, so it's important to know that you can prevent Medicare from sharing this information at any time.

To prevent your information from being shared, you can call 1-800 MEDICARE (1-800-663-4227). TTY users should call 1-877-486-2048 and tell the operator you are calling about an ACO.

Medicare will not share any information about alcohol and drug treatment history, unless you choose, in writing, to share it.

After your form or phone call is received, Medicare will update its records to show that you do not want to have your data shared. If you call 1- 800 Medicare, you will receive a letter confirming this change. It will take about 45 days for this change to take effect.

What if I change my mind and decide that I do want my personal health information shared in the future?

If you change your mind in the future,  you can call 1-800 Medicare (1-800-663-4227) and tell them that you have changed your mind and that you do want your data shared. You will receive a letter confirming this change.

What if I change my mind later and decide that I do not want information shared about drug and alcohol treatment?

You can change your mind at any time. All you need to do is call 1-800 Medicare and tell them that you no longer wish to have your drug and alcohol treatment information shared. You will receive a letter confirming the change and it will take about 45 days to take effect.

How long do I have to respond, indicating that I do not want my personal health information shared with the ACO?

Medicare values your privacy. For that reason, you can prevent Medicare from sharing your personal health information, or otherwise change any of your preferences, at any time. Just call 1-800 MEDICARE, and they can help you set your preferences the way you want them. You can also return the "Declining to Share Personal Health Information" form to our office.

I recently enrolled in an MA Plan, but I also received a notice that my provider was part of an ACO. Does that change anything?

Because you chose to enroll in a Medicare Advantage Plan, the notice you received about Accountable Care Organizations (ACOs) no longer applies. Please disregard it.

What if I am already happy with my care the way it is?

We're glad you're having a positive experience already. Even though your provider is participating in an ACO, you can continue to see him the way you have been. Your provider's participation in an ACO won't change your benefits in any way, and decisions about your care stay with you and your provider.

How will being in an ACO help my provider?

Doctors in ACOs may have better access to the expertise, staff, and technology they need to make sure your care is coordinated across all the places you receive services. For you, this coordination could mean less paperwork to fill out at the doctor's office, avoiding unnecessary tests, or it may mean more help for you in dealing with any health conditions.

My relative received a letter from the ACO, but passed away recently, what do I need to do?

We are sorry about your loss. These letters were sent because of your relative's history of receiving care from their provider, who is participating in the ACO. You don't need to do anything further. Over time, your relative will be removed from the list of patients affiliated with their provider.