BJC Accountable Care Organization
When your doctors can communicate more easily, you’ll receive better care that meets your unique needs. That’s our goal as the first Accountable Care Organization (ACO) in the St. Louis area. We work together with Medicare to provide high-quality service and care at the right time and in the right setting.
Discover information about participating in the BJC ACO, answers to frequently asked questions, and view other helpful resources.
The federal government is changing the basis of reimbursement for all providers of care -- paying for patient outcomes rather than for episodes of care:
BJC has the ability and resources to leverage its experience with this model, which will help bring more stability to provider reimbursements
The core objective is to improve the quality of patient care and provide better health for patient populations while lowering the growth in health care costs
This is possible only through better collaboration between hospitals, physician groups and patients
You can develop more collaborative relationships between hospitals and other physicians
More collaboration helps ensure better patient outcomes at more efficient costs while providing opportunities for you to share in Medicare cost savings
Initial focus assists in managing patients as part of the Medicare Shared Savings Program
Financial incentives are based on patient outcomes, with attention to value and quality of care
This is a framework for BJC to support participating physicians and practices
BJC will help in developing the systems, resources and services necessary to improve patient and population health, and control costs
It enhances access and continuity, thus accommodating patients' needs with:
Access and advice during and after hours
Enhanced communications with patients and their families
More coordination with other providers involved in care
It identifies and coordinates patient populations by:
Planning and coordinating care
Using evidence-based guidelines for preventive, acute and chronic care coordination, including medication coordination
It provides self-care support and community resources to:
Assist patients and their families in self-care coordination with information, tools and resources
Track and coordinate care, including tests, referrals and transitions of care
It measures and improves performance by:
Using performance and patient experience data for continuous quality improvement
Regardless of whether a provider chooses to participate in an ACO, their patients with Medicare may continue to see them.
Thanks to a new ruling, physicians who participate in the BJC Accountable Care Organization (ACO) are now able to directly admit their ACO Medicare patients into an approved skilled nursing facility to continue their recovery. Normally, Medicare patients are required to have a three-day inpatient hospital stay prior to transferring to a skilled nursing facility for therapy services.
The ruling that began in 2017 allows ACO physicians to admit ACO patients to an approved skilled nursing facility from the patient’s home, the physician’s office, from an emergency room or from the hospital, even when they don’t have a three-day inpatient stay.
Only skilled nursing facilities that have received three or more stars under the CMS Five-Star Nursing Home Quality Rating System were approved to affiliate with BJC ACO for patients’ care. BJC has affiliation agreements with 31 facilities to ensure patients have a choice and continue to receive excellent care.
To be eligible, Medicare patients must not already live in a long-term care or skilled nursing facility and must also meet the following criteria:
Be medically stable
Have a confirmed diagnosis
Must not require inpatient hospital evaluation or treatment
Have an identified skilled nursing or rehabilitation need that cannot be provided on an outpatient basis or through home health services
Patients still have the option to go to a skilled nursing facility that is not affiliated with the ACO; however, normal Medicare requirements will apply, including the requirement for a three-day inpatient hospitalization.