VillageMD Primary Providers ACO IV

Your doctor’s participation in an ACO enhances your benefits at no extra charge to you. However, you are still responsible for any regular co-insurance costs not covered by Medicare. Below is a list of some of the benefits you will find as a member of our ACO.

• Helps your doctors know your health history and talk to one another about your care and coordinate your health care needs.
• May save you time and money by avoiding repeated tests and unneeded appointments.
• May make it easier to spot potential problems before they become more serious—like drug interactions that can happen if one doctor isn’t aware of what another has prescribed.
• Access to expanded benefits at no extra cost. Ask your health care provider if you qualify.
  • Home Health Homebound Waiver for patients with two or more chronic conditions.
  • Virtual Care Expansion Waiver
  • Three Day Skilled Nursing Facility Waiver
  • Nurse Practitioner/Physician Assistant Services Waiver
  • Concurrent Care for patients that elect Medicare Hospice
    • Allows patients with a known cancer or end stage renal disease (ESRD) diagnosis or patient entering a skilled nursing facility to enroll in hospice care while still allowing them to benefit from symptom management such as pain control, oncology treatments or dialysis.
  • Chronic Disease Management Reward
    • Allows aligned patients to receive a nominal gift card for participating in their care.
  • Cost-Sharing for Medicare Part B Services
    • Allows aligned patients to achieve a higher quality of life by reducing financial barriers to advance one or more of the following clinical goals: 1) Adherence to a treatment regimen 2) Adherence to a drug regiment 3) Adherence to a follow up care plan and management of a chronic disease or condition 4) Better manage of patients high cost and chronic conditions.

Important! An ACO won’t limit your choice of health care providers. It isn’t a Medicare Advantage Plan. If your doctor is part of an ACO, you still have the right to visit any doctor, hospital, or other provider that accepts Medicare at any time.

One of the most important benefits of an ACO is that your doctors and other providers can communicate and coordinate your care. To help with that, Medicare gives certain information about your care to your health care providers’ ACO. Sharing your data in this way helps make sure all the people involved in your care have access to your health information when and where they need it, to work together to get you the care you need. If you don’t want Medicare to share your health care information this way, call 1-800-MEDICARE (1-800-633-4227) and tell that to the representative. TTY users can call 1-877-486-2048. If you decide you don’t want Medicare to give your health care information to your doctors, Medicare will continue to use your information for some purposes, like evaluating financial performance and quality of care.

To learn more about ACO's, visit https://www.medicare.gov/ or call 1-800-MEDICARE. TTY users can call 1-877-486-2048.

ACOs are under an agreement with Centers for Medicare and Medicaid Services (CMS) to participate in the Realizing Equity, Access, and Community Health (ACO REACH) Model.

Your benefits will NOT change, and you can visit any doctor, other health care professional, or hospital.

Please see above for the list of all providers participating in the ACO.

Please click here to schedule an appointment with a provider. 

Medical records are located on a separate secured network. Access to the secure network is granted only to appropriate staff and physicians, who have received extensive training on the system.  Doctors, hospitals and other health care providers working together in the ACO will access your medical records only when necessary, to help improve your care.  Sharing medical information with providers with-in the ACO allows us to identify your specific care needs.  The privacy and security of your medical information is protected by federal law.

If you choose, you can decline to have your Medicare claims information shared with us by calling 1-800-MEDICARE (1-800-633-4227).  TTY users should call 1-877-486-2048

Shared Savings/Loss:  $378,748.33

 Shared Savings Distribution:

• Proportion invested in infrastructure: 50%
• Proportion invested in redesigned care processes/resources: 25%
• Proportion of distribution to ACO participants: 25%

 Quality Performance Results:

• Risk-Standardized, All-Condition Readmission: 15.22
• Risk-Standardized, All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (per 100 person-years):  32.11

Shared Savings/Loss:  $6,509,753.41

 Shared Savings Distribution:

• Proportion invested in infrastructure: 50%
• Proportion invested in redesigned care processes/resources: 25%
• Proportion of distribution to ACO participants: 25%

 Quality Performance Results:

• Risk-Standardized, All-Condition Readmission: 15.22
• Risk-Standardized, All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (per 100 person-years):  31.45
• Timely Follow Up After Acute Exacerbation of Chronic Conditions: 72.48

 

Amount of Shared Savings/Loss: $16,694,632.27

 Shared Savings Distribution:

• Proportion invested in infrastructure: 50%
• Proportion invested in redesigned care processes/resources: 25%
• Proportion of distribution to ACO participants: 25%