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UC San Diego Health Accountable Care Network

ACO Beneficiary Fact Sheet

Accountable Care Organizations and You – from the Centers for Medicare and Medicaid Services

Your doctor may be participating in UC San Diego Health Accountable Care Network, a Medicare Shared Saving Program ACO. An ACO is a group of doctors, hospitals, and/or other health care providers working together with Medicare to give you better, more coordinated service and health care. We share important information and resources about your individual needs and preferences.

  • The providers who are part of our ACO have been evaluated to ensure they can provide high-quality care. This includes maps and contact info for the clinics, hospitals and skilled nursing facilities in our ACO.
  • Medicare Annual Wellness Visits ensure that your important upcoming health maintenance opportunities are identified and scheduled.
  • Learn more about ACOs by visiting Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

Attention Medical Providers: If you are affiliated with the Accountable Care Network, visit ucsdhn.org

Frequently Asked Questions

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What is a Medicare Shared Savings Program ACO?

A Medicare Shared Savings Program Accountable Care Organization (ACO) is a group of doctors and other health care providers who agree to work together with Medicare to give better, more coordinated health care to individuals with Original Medicare, also known as Medicare fee-for-service or Medicare Parts A and B.

You Can Still Choose Any Doctor or Hospital

Your Medicare benefits are not changing. An ACO is not a Medicare Advantage plan, an HMO plan, or an insurance plan of any kind. You still have the right to use any doctor or hospital that accepts Medicare, at any time. Your doctor may recommend that you see particular doctors or health care providers, but it's always your choice about what doctors and providers you use or hospitals you visit.

I have a Medicare Advantage Plan. Does an ACO have anything to do with me?

No. Only people with Original Medicare (Medicare fee-for-service) can be assigned to an ACO. You can't be assigned to an ACO if you have a Medicare Advantage Plan (like an HMO or a Preferred Provider Organization). Please visit health.ucsd.edu/medicare to learn more about different types of Medicare accepted at UC San Diego Health.

How do ACOs coordinate patient care?

The goal of the ACO is to support your doctors in caring for you by making sure they have the most up-to-date information about your health and your care. For you, this coordination could mean less paperwork to fill out at the doctor's office, avoiding unnecessary tests, and more awareness of treatment options for various health conditions. By working together, your doctors can do more to monitor your health and make sure you receive the highest quality care.

How do I know if a doctor participates in an ACO?

Doctors or health care providers who choose to participate in an ACO must display a poster that notifies you of your doctor's participation in an ACO. If you aren't sure if your doctor or health care provider is participating in a Medicare Shared Savings Program ACO, ask him or her during your visit. For general information about ACOs, call 1-800-MEDICARE.
See our Participating providers

How does being in an ACO help my doctor?

Doctors and other health care providers choose to participate in an ACO because they're committed to providing you with a better care experience. They may also be rewarded financially for offering you better, more coordinated care while keeping health care costs low. Doctors in ACOs may also have greater access to the expertise, staff, and technologies they need to make sure your care is coordinated across all the places you get services.

Can I still see my other regular Medicare doctors and health care providers, even though my primary doctor participates in an ACO?

Yes, that doesn't change. Always keep in mind that you can still go to any doctor, hospital, or other provider that accepts Medicare. Nobody can restrict which providers you see. You still have Original Medicare (Medicare fee-for-service). And you still have all the same Medicare services, benefits and protections.

My doctor's office said I could select my primary clinician through Medicare. How do I do that?

You can create an account on MyMedicare.gov and select your primary clinician through the website, or you can call 1-800-MEDICARE (1-800-633-4227). Your primary clinician is the health care provider that you believe is responsible for coordinating your overall care. Selecting a primary clinician doesn't affect your benefits or restrict your ability to get care from any doctor or other clinician you choose. Your selection of a primary clinician will remain the same unless you decide to change your designation.

What information about me will the ACO have access to?

Medicare shares information about your care with the ACO, including medical conditions, prescriptions, and visits to the doctor. Your health care information helps the ACO track the services you've already received, understand where you may need more care, and find ways to smooth the transition for you if you have to transfer in or out of a hospital, or from the care of one doctor to another.

If you choose to let Medicare share your health care information with UC San Diego Health Accountable Care Network, it may also be shared with other ACOs in which your other doctors or health care providers participate. If you don't want your health care information shared, you can ask Medicare not to share it. Having your health information gives us a more complete picture of your health.

What if I don't want to share my information with ACOs?

Your Privacy is Very Important to Us. Just like Medicare, ACOs must put important safeguards in place to make sure all your health care information is safe. ACOs respect your choice on the use of your health care information for care coordination and quality improvement.

Yes, share my information: If you want Medicare to share information about the health care you received with UC San Diego Health Accountable Care Organization or with other ACOs in which your other doctors or health care providers participate, there's nothing more you need to do.

No, please don't share my information: If you do not want Medicare to share your health care information, you need to do the following:

  • Call 1-800-MEDICARE (1-800-633-4227). Tell the representative that your doctor is part of an ACO and you do not want Medicare to share your health care information. TTY users should call 1-877-486-2048.
  • If you change your mind in the future, call 1-800-MEDICARE and tell the representative what you have decided. We can't communicate with Medicare on your behalf.

Even if you decline to share your health care information, Medicare will still use your information for some purposes, like assessing the financial and quality of care performance of the providers participating in ACOs. Also, Medicare may share some of your health care information with ACOs when measuring the quality of care given by health care providers participating in those ACOs.

I am having trouble managing my health at home. Are there resources within the ACO that can help me?

Yes. If you are enrolled in the ACO and you are struggling with your health or having difficulty managing your health at home, your doctor can refer you to our Population Health Care Team. The team is made up of social workers, nurse case managers, pharmacists, and care navigators who work closely with your primary care physician. The team can support you in a variety of ways depending on your condition and your situation. For example, the team can help ensure a smooth transition from the hospital to a skilled nursing facility. They can provide support over the phone for a health issue you are facing, or assist with medical appointment reminders. These services are a benefit of being enrolled in the ACO and are covered by Medicare to help you get well, stay out of the hospital, and/or avoid more serious issues with your health. For more information, call the Population Health Care Team at 844-827-3264.