Accountable Care Organizations (ACO)
If you are a Medicare patient, you may have recently received a letter regarding a new Accountable Care Organization (ACO) named PRICARE. PRICARE is an ACO set up & owned by the physicians of Family Practice Associates along with 3 other primary care groups in this area.
The purpose of PRICARE ACO is to utilize information from Medicare to help improve the quality of care for our patients and to reduce the costs for Medicare. Medicare is promoting ACOs as the new model of care for the future.
For that reason, FPA formed PRICARE ACO. We are voluntarily participating in this ACO, and we would like our Medicare patients to participate in it as well. It will not affect our Medicare patients in any negative way, only positively by enhancing your care.
The PRICARE ACO, which consists of FPA providers, does not share your information inappropriately. We always abide by strict HIPAA guidelines for patient privacy.
You do not have to do anything to participate in the ACO. You will be enrolled in our ACO, unless you send in the Declining to Participate form that was included in your letter.
For more information about the PRICARE ACO including a list of the Board of Directors, please visit http://pricare.azurewebsites.net.
Frequently Asked Questions
What is Pricare ACO?
Pricare is an Accountable Care Organization that includes the providers at Family Practice Associates of Lexington and 3 other primary care groups in this area
What is an ACO?
An Accountable Care Organization is a group of providers that are participating in a new type of organization to promote better quality care and lower costs for traditional Medicare patients. It is being encouraged and promoted by Medicare, so your physicians at FPA are participating.
Do I need to do anything?
No, you will automatically be included in the ACO unless you choose not to share your information. There is no cost or changes for the patient at all. We encourage our patients to participate.
Who has access to my information?
Access to your medical information is the same as before. Providers who are active in your treatment have access to your medical information along with your insurance carrier (Medicare) and the ACO. Your medical information is always treated confidentially and not shared with anyone who is not involved in your care. We continue to follow strict HIPAA regulations for privacy.
Does it affect my insurance?
No, your Medicare insurance does NOT change at all. This is NOT a Medicare Advantage plan or HMO. You are always free to choose any doctor or hospital who accepts Medicare. We will continue to bill Medicare for services provided at FPA.
What if I am enrolled in a Medicare Advantage plan?
If you are enrolled in a Medicare Advantage plan, such as Humana, then please disregard the letter. The ACO applies for patients enrolled in traditional Medicare, not a Medicare Advantage plan.
Am I going to lose my doctor?
No, you will NOT lose your doctor. You can continue to see your primary care provider as you normally do. You are always free to choose any doctor or hospital who accepts Medicare.
How is it better for me?
Through the ACO, FPA will be performing a lot of work behind the scenes to be sure that our patients are receiving appropriate follow-up appointments, testing and care coordination. The goal is for patients to get better quality of care while lowering the costs for Medicare. We encourage you to remain in the ACO.
Why is FPA participating in the ACO?
Medicare is promoting ACOs as a new way to increase quality of care and lower Medicare costs. Because FPA is a certified Patient Centered Medical Home (PCMH), we are already performing many of the functions required by an ACO model and feel that the ACO will benefit our patients.