JANUARY 2016 ON HEALTH CONSUMER REPORTS 11 ConsumerReports.org/health ILLUSTRATION: MICHAEL AUSTIN/THE ISPOT.COM M y medical practice will soon join an accountable care organization, or ACO. I’ll then be part of a group of doctors, hospitals, and other health care providers who have come together to offer “high-value care.” That means bringing higher-quality care to patients and lowering costs by reducing the use of unnecessary tests and treatment. I’m signing on because it will give me access to a larger team of physicians and other experts to help me manage patients. You may already be one of the roughly 24 million Americans (including 6 million Medicare users) who are being served by an ACO. If not, physician participation is in- creasing, so you are likely to get a letter in the near future from one or more of your health care providers informing you of his or her participation in an ACO. ACOs 101 The ACO that I am joining is a Medicare ACO, which means all of the providers accept Medicare’s traditional insurance. (Someothersacceptprivateinsurance.)The DepartmentofHealthandHumanServices is encouraging more Medicare health care providers to consider models like ACOs, in part to curtail runaway health care expenses—which are leading to higher Medicare premiums for some consumers. How? Under the traditional fee-for- service payment system, health care providers are compensated for each office visit, test, and procedure—the greater the volume, the more we are paid. An ACO is financially rewarded for keeping patients healthy and driving down the number of tests, procedures, and doctors’ visits that have no clear benefit to the patient. A key part of that is ensuring that providers communicate more closely and help their patients—especially those who have chronic illnesses such as high blood pres- sure or heart disease—select the right treat- ments and skip those that are unneeded. The Proactive Patient THE NEW OFFICE VISIT If your doctor joins an ACO, your office visits may start to have more emphasis on preventive services and strategies for stay- ing well. If you have a chronic condition such as diabetes, for instance, you and your doctor may spend more time discussing ideas for stabilizing your blood sugar. You may also find that you have a larger health care team. An ACO won’t reduce your time with your doctor, but he may assign a high-level nurse to help you man- age your diabetes or other complex illness. Or an ACO’s pharmacist may contact you to discuss your medications. You will also be given the choice of whether you want your health data to be shared within the ACO. That allows the doctors to study your information—along withdatafrommanyotherpatients—tode- termine how to provide the best care for all. SMART STEPS If you get a letter informing you that your doctor, hospital, or network has joined an ACO, it’s important to do the following: àWhenprovidersjoin anACO,theyarerequiredtoinformpatients. Decide whether you want to stay with your currentprovider.Youcanseekanotherphysi- cian if you don’t want to participate in an ACO—if, for example, you’re concerned that it may restrict access to specialists or tests. àAsk your provider to clearly explain what changes you may expect to see as a result of her participation in an ACO. àFind out what extras, such as wellness programs or opportunities to work with nurses and other health care professionals, you may have through the ACO. àGoing forward, pay close attention to referrals you receive to other health care professionals. Your doctor will probably refer you only to hospitals and specialists within the ACO network. If you have other preferences, ask your provider whether he will help you see a doctor of your choice. àIf you believe that you need a medical test or procedure and your doctor declines, that may be a reflection of the ACO’s cost- saving efforts. But it’s more likely to be a reflection of better medical care. If you’re uncertain, ask your doctor why the test or procedure should not be done and which medical guidelines he or she is following. When health care expenditures rise, some of those end up in your insurance premiums, as we have seen in the price hikes projected for Medicare. I hope that ACOs and similar programs will get rid of current fee-for-service incentives to do more, and encourage health care profes- sionals to spend more wisely. Orly Avitzur, M.D., M.B.A., is Consumer Reports’ medical director. Board certified in neurology, she is a fellow of the American Academy of Neurology, a clinical instructor at the Yale University School of Medicine, and a medical consultant to the New York Rangers hockey team. Is Better Care In Your Future? How accountable care organizations are changing the way doctors tend to patients, and how to get the best from them Orly Avitzur M.D., M.B.A. If your doctor joins an ACO, office visits may have more emphasis on preventive services and strategies for staying well.