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. 

Resources for providers.

Discover information about participating in the BJC ACO, answers to frequently asked questions, and view other helpful resources. 

Frequently asked questions from providers.

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.

New ruling allows BJC ACO to directly admit patients to a skilled nursing facility. 

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.  

To determine if a patient is eligible for an ACO SNF waiver, contact the care management team at (314) 996-7020 or toll-free (844) 996-7020

Download the Patient Information Handout