Accountable Care Organizations

An Accountable Care Organization (ACO) is a group of hospitals and doctors that are responsible for the quality and cost of care for a group of people. An ACO is supposed to help providers work together to coordinate care, improve quality and reduce costs.

An ACO signs contracts with doctors, hospitals, and insurers. The ACO takes responsibility for the care of a group of people. In return, an ACO receives payments from insurers for the group of people they care for.

Often, these payments are advance payments. Such advance payments give providers income that is more predictable than normal fee-for-service payments. Also, a small portion of these payments are only paid if the ACO meets quality goals. Due to this, the ACO may be incentived to reduce costs and improve quality.

An ACO makes money if the cost of care for a certain group of people is less than expected. The ACO loses money if the cost of care for that group is higher than expected. By potentially losing money, an ACO bears some of the risk that would normally be borne by an insurer.

Some people believe that ACOs motivate providers to be more efficient and to provide care in new ways. Other people argue that ACOs add more complexity to the health care system and that ACO providers may limit services in order to save money. Researchers do not agree which side is correct.

Currently, OneCare Vermont (OneCare) is the only Vermont ACO. OneCare was founded by the University of Vermont Medical Center and Dartmouth-Hitchcock Health Care.

In 2018, OneCare contracted with Medicare, Vermont Medicaid, Blue Cross Blue Shield of Vermont (for its Vermont Health Connect plans), and some self-funded health plans. OneCare is responsible for the care of more than 110,000 Vermonters.

The Green Mountain Care Board regulates Vermont ACOs. ACOs must be certified by the board. Each ACO must submit its budget to the board every year. Learn more about how the board regulates Vermont ACOs.

Yes. ACOs are not like managed care insurance plans. You are free to choose your providers just like you were before your doctor joined OneCare. However, your doctor may be more likely to refer you to other OneCare providers.

You may notice that your doctor is doing more to coordinate your care. This could mean talking more with your other providers, using new technology, or helping you access community resources. On the other hand, you might feel that you do not have access to the services you need or be concerned about the quality of the services you get. If that happens, contact the Office of the Health Care Advocate at 800-917-7787 to get free help. It is also possible that you will not notice any change.

You should not receive less care because your doctor is part of OneCare. OneCare is supposed to save money by coordinating care to keep people healthier, not by limiting your care. Providers that are part of OneCare should give you the same quality of care, or better, than before.

Some providers may try to save money by limiting your care. If you feel that you do not have access to the services you need or if you are concerned about the quality of the services, contact the Office of the Health Care Advocate at 800-917-7787 to get free help.

Call OneCare toll-free at 877-0644-7176, option 2, to find out whether OneCare is responsible for your care.

No, you cannot opt out of OneCare.

OneCare allows you to limit how they use and share your personal health information. Contact OneCare directly to limit how they can use and share your personal health information. If you don’t know how to contact OneCare, call the Office of the Health Care Advocate at 800-917-7787 to get free help.

Call OneCare toll-free at 877-0644-7176, option 2. You can also contact the Office of the Health Care Advocate at 800-917-7787 to get free help.