2025 Medicare Reimbursement Rates
The standardized payment amounts set by CMS for medical services, including a 2.83% cut in the physician conversion factor.
2025 Proposed Physician Fee Schedule
A CMS-issued draft that outlines the upcoming year’s payment policies and invites public input on coding, care management services, and telehealth policy changes
Advantages of ACO
Include better care coordination, improved patient outcomes, reduced healthcare costs, and financial incentives for providers.
ACO (Accountable Care Organization)
A group of doctors, hospitals, and other healthcare providers who voluntarily collaborate to deliver coordinated, high-quality care to Medicare patients.
ACO Agreement Period
The duration of time an ACO is contracted with CMS to participate in a program like MSSP.
ACO Benefits
Include improved care coordination, lower healthcare costs, better patient outcomes, and financial incentives for providers.
ACO Cost Saving
Refers to the reduction in healthcare spending achieved through coordinated care, efficient resource use, and prevention of unnecessary services.
ACO EMR Integration Support
Assistance provided to connect electronic medical records with ACO systems for seamless data sharing and reporting.
ACO Expansion Opportunities
Programs and models that help providers grow value-based care through flexible contracts and support.
ACO For Providers
A group-based care model that helps doctors coordinate patient care while earning shared savings through Medicare or commercial contracts.
ACO Governing Body
The leadership structure responsible for oversight and strategic direction of the ACO.
ACO Group
A network of healthcare providers and organizations that collaborate to deliver coordinated, high-quality care under a shared savings model.
ACO Healthcare
A care delivery model where providers work together to improve quality, reduce costs, and share financial savings in managing patient populations.
ACO Health Plan
An insurance option that partners with an Accountable Care Organization to offer coordinated, value-based care to its members.
ACOs in Healthcare
Groups of providers that collaborate to deliver coordinated, high-quality care while reducing costs under value-based payment models.
ACO Management
The oversight and coordination of operations, data, compliance, and care strategies within an Accountable Care Organization to meet quality and cost goals.
ACO MSSP
A federal initiative that allows ACOs to earn shared savings by improving care quality and reducing costs for Medicare fee-for-service beneficiaries.
ACO Near Me
A local network of healthcare providers that work together to deliver coordinated, value-based care under an ACO model.
ACO Network for Doctors
A collaborative organization of physicians, hospitals, clinics, and other care providers who share responsibility for coordinating care, managing quality and costs, and collectively serving a defined patient population under value-based payment models.
ACO Onboarding Process
The process of enrolling providers and aligning them with value-based care systems.
ACO Participation
When providers join a coordinated care network to improve quality and share in Medicare savings.
ACO Participation Benefits for Providers
Include shared savings, performance bonuses, and improved care coordination support.
ACO Participation Options / ACO Contracting Models
The various frameworks through which providers can join ACOs, each outlining different levels of financial risk, shared savings, and regulatory requirements based on the organization's structure and goals.
ACO Partnership Opportunities
Programs and collaborations that enable providers to form or expand ACOs, access funding and data infrastructure, and participate in shared‑savings value‑based care arrangements.
ACO Patient Population
The group of patients an ACO is responsible for managing under value-based care.
ACO Payment Model
A value-based reimbursement system where providers share savings or losses based on the cost and quality of patient care.
ACO Primary Care Flex Model
A CMS program that gives low-revenue ACOs upfront and monthly payments to support advanced primary care instead of fee-for-service billing.
ACO Provider Alignment Strategies
Methods to engage and incentivize providers to achieve shared quality and cost goals.
ACO Provider Support
Includes tools and services that help doctors succeed in value-based care.
ACO Quality Benchmarks
Standardized performance measures used to assess how well an ACO delivers high-quality, coordinated, and cost-effective care to its patient population.
ACO Quality Measures
Standardized benchmarks used to assess patient care, outcomes, and cost efficiency in value-based programs.
ACO Quality Metrics
Specific data points used to evaluate how well an ACO delivers care in areas like prevention, chronic disease management, and patient satisfaction.
ACO Quality Reporting Tools (CQM, eCQM)
Standardized systems used to measure and report provider performance on specific clinical quality metrics.
ACO REACH
A CMS model (Realizing Equity, Access, and Community Health) that builds on Direct Contracting to promote health equity and advanced risk-sharing.
ACO REACH vs MSSP
ACO REACH is more advanced, equity-focused, and risk-intensive; MSSP is more widely used and beginner-friendly.
ACO Risk Adjustment
The process of modifying payments and performance benchmarks based on the health status and complexity of assigned patients.
ACO Services
Coordinated care activities like chronic disease management, preventive care, care transitions, data reporting, and patient outreach designed to improve quality and reduce costs.
Advanced APM (Alternative Payment Model)
A payment model that includes both upside and downside financial risk and qualifies for additional CMS incentives.
Alternative Payment Model (APM)
A payment approach that incentivizes high-quality, cost-efficient care, often tied to specific conditions or populations.
Attribution
The process of assigning patients to a provider or ACO for accountability and performance measurement.
Automated Risk Stratification
A system that categorizes patients by health risk level using algorithms and clinical data.
Benchmark
A spending target or quality threshold used to evaluate ACO performance.
Beneficiary
A person enrolled in Medicare or Medicaid who receives healthcare services.
Benefits of Accountable Care Organizations
Improved care coordination, reduced healthcare costs, enhanced patient outcomes, and shared savings for participating providers.
Best ACO for Independent Providers
Often the ACO REACH Model, particularly its High‑Needs Population ACO (HNACO) track, because it allows provider-led entities to take on advanced risk in exchange for higher shared savings, offers customized benchmarking for complex patients, and maintains provider control over governance and care models.
CAHPS (Consumer Assessment of Healthcare Providers and Systems)
A standardized survey tool that measures patient experience and satisfaction.
Capitation
A payment model where providers receive a fixed amount per patient, regardless of how many services are provided.
Care Coordination
The organization of patient care activities to ensure appropriate and efficient delivery of healthcare services.
Care Gap
A missed or overdue preventive or chronic care service that may impact patient outcomes.
Care Gap Closure Tools
Systems that identify and track unmet patient care needs based on clinical guidelines and quality measures.
Care Transformation
The systematic redesign of care delivery processes to improve patient outcomes, enhance coordination, and reduce costs through value-based, patient-centered approaches.
Chronic Care Management (CCM)
Services provided to patients with multiple chronic conditions to improve health outcomes and reduce hospitalizations.
Claims Analytics for Providers
Data tools that examine insurance claims to reveal patterns in care delivery and spending.
Clinical Integration
The alignment of healthcare providers across settings to improve care coordination and outcomes.
Clinical Performance Dashboards
Visual tools that display key metrics on provider quality, outcomes, and efficiency.
CMS Value-Based Care Initiatives
Programs launched by CMS that reward healthcare providers for delivering high-quality, cost-efficient, and patient-centered care rather than volume-based services.
Downside Risk
A financial arrangement where providers are responsible for losses if care costs exceed benchmarks.
EHR (Electronic Health Record)
A digital version of a patient’s medical history used to support care coordination and data sharing.
EHR API Integration
The process of connecting external applications to EHR systems to enable data exchange and automation.
HEDIS (Healthcare Effectiveness Data and Information Set)
A widely used set of performance measures in managed care.
How to Enroll in an ACO
Sign a participation agreement with the ACO, align with its care and reporting standards, and begin coordinating care under value-based payment models.
Interoperability
The ability of different health IT systems to exchange and use patient data effectively.
Integrated Data Platform for ACOs
A centralized system that combines clinical, claims, and administrative data to support coordinated care and performance tracking.
Medicare ACO in Alabama
Medicare ACO in Arizona
Medicare ACO in California
Medicare ACO in Connecticut
Medicare ACO in District of Columbia
Medicare ACO in Florida
Medicare ACO in Georgia
Medicare ACO in Illinois
Medicare ACO in Indiana
Medicare ACO in Iowa
Medicare ACO in Kentucky
Medicare ACO in Louisiana
Medicare ACO in Maryland
Medicare ACO in Michigan
Medicare ACO in Mississippi
Medicare ACO in Nebraska
Medicare ACO in New Jersey
Medicare ACO in New York
Medicare ACO in North Carolina
Medicare ACO in Ohio
Medicare ACO in Pennsylvania
Medicare ACO South Carolina
Medicare ACO in Tennessee
Medicare ACO in Texas
Medicare ACO in Virginia
MSSP (Medicare Shared Savings Program)
A CMS program that incentivizes ACOs to reduce healthcare costs while meeting quality benchmarks for Medicare beneficiaries.
Multi-State ACO Participation
The arrangement by which an Accountable Care Organization operates and includes providers across two or more U.S. states.
Patient-Centered Medical Home (PCMH)
A care model that emphasizes comprehensive, coordinated, and accessible care centered around the patient.
Patient Attribution Management
The process of assigning patients to specific providers or organizations for accountability in value-based care.
Physician Autonomy in Value-Based Care
Allows doctors to make clinical decisions while aligning with quality and cost goals.
Physician Independence in ACO
Refers to doctors maintaining clinical decision-making authority while participating in collaborative, value-based care networks.
Physician Opportunities in ACOs
Joining collaborative care networks that offer shared savings, value-based incentives, and support for improving patient outcomes.
Population Health
A strategy focused on improving health outcomes for a defined group by addressing clinical and social determinants of health.
Predictive Analytics for Population Health
Data models that forecast health outcomes and risks across patient groups.
Preventive Care
Health services that prevent illness or detect issues early, such as screenings and immunizations.
Primary Care Practice Growth Strategies
Expanding services, improving patient retention, and joining value-based care models like ACOs.
Primary Care Transformation
The shift from traditional reactive care to proactive, team-based, and value-driven primary care models.
Primary Care Redesign
The shift toward team-based, patient-centered care that improves outcomes through better coordination, access, and prevention.
Private Practice ACO Support
Includes help with data reporting, care coordination, and maximizing value-based reimbursement.
Quality Measures
Metrics used to assess the effectiveness, safety, and patient-centeredness of care.
Risk Adjustment
A method to account for the health status of patients when comparing provider performance or setting payment benchmarks.
Real-Time Clinical Decision Support
Support that provides instant, data-driven guidance to help providers make informed care decisions during patient visits.
Regional ACO Support Teams
Dedicated groups that assist providers within a specific geographic area by offering localized expertise in care coordination, reporting, and value-based reimbursement.
Shared Savings
A financial incentive where providers share in cost savings achieved through efficient, high-quality care.
Sidekick
PBACO’s proprietary platform designed to support real-time data access, patient engagement, and workflow automation.
Two-Sided Risk Model
A model where providers share in both savings and losses.
Upside Risk
A financial model where providers can share in savings but are not liable for losses.
Value-Based Care
A healthcare delivery model that rewards providers for quality and outcomes rather than volume of services.
