ACO's are all the rage this fall when looking at small group options for 2018. They have actually been around for several years, but they are gaining steam when considering options for your group plan.
What is an ACO? In an account care organization (ACO), the insurer and the provider network work together to deliver a level of integrated health care at a cost significantly less than the open access network. This may remind some of you of the old HMO (health maintenance organization) plans, where you picked your primary clinic, and had to get referrals for seeing a specialist. ACO's do not require referrals to see a specialist, as long as they are within the ACO network. If care is not available within the network, the ACO provider will direct the member to an appropriate provider outside the system. Because the member gets all of their health care within one system, this usually drives better patient management and improves the overall experience. Most of the ACO networks do not include Mayo Clinic (unless you choose the Mayo Clinic Health System ACO), but the good news is that you can save 10-15% in premium from the open access network. Once you've made the decision to try one of the ACO concepts, Medica has found that 60% of members enroll again the following year.
Medica, HealthPartners, Blue Cross, and Preferred One have all found value in offering this concept. Medica offers a Fairview & North Memorial ACO, HealthEast, Park Nicollet, and Ridgeview Community ACO option in the metro area. Other options are available out of the metro. HealthPartners launched their CentraChoice ACO in the St Cloud area for 2018. A close alternative to ACO's have been "Care Systems" like Medica's Elect/Essential, HealthPartner's Perform and Achieve, Blue Cross' Blue Value and new this year is the High Value network. Preferred One also offers their Connect and Horizon networks, which can save anywhere from 3-17% in some cases.
Let us know if you're interested in exploring these options to help keep your premium down. An ACO or Care System can work very well for a small group living in an area with fewer providers, or a larger group that has enough participants to offer multiple plans. If your renewal is coming up, this is a concept to keep in mind, as we're all looking for ways to keep health care costs to a minimum.