Accountable Care Organization

Accountable Care Organization (ACO) Compliance Review and Advisory Services

Strategic Management has been providing compliance related services to health care organizations for more than 20 years. Since the release of the Medicare Shared Savings Program (MSSP) regulations, we have worked with managed care organizations and provider organizations, such as physician practices, hospitals and other health care providers, on the development and implementation of Accountable Care Organizations (ACOs).

ACOs are defined by CMS as a group of doctors, hospitals, and other health care providers who voluntarily and jointly coordinate high quality care to Medicare beneficiaries. There are various types of regulated ACOs. For instance, the most common is the Medicare Shared Savings Program which, by design, has regulatory requirements that are less prescriptive than those related to managed care, for instance. This leaves more to interpretation and creates the need for guidance related to the reasonable implementation of MSSP regulatory requirements. Other types include Advance Payment ACO Models and / or other state-specific ACO-type initiatives such as those in California, for example.

Strategic Management and its knowledgeable and experienced consultants can help health care organizations with their compliance needs. We provide the following services and more. For more information regarding our advisory services related to managed care, contact us at (703) 683-9600 or by filling out our online contact form.

Compliance Program Services

Compliance Program Reviews, Development and Implementation for ACO and ACO Type Entities:

ACO compliance program development and implementation services.
ACO compliance program resource and organizational planning.
Review organizational structure of existing compliance program, initiatives and resources (i.e., designated compliance official).
Evaluate and assess effectiveness of ACO compliance programs including identifying strengths/accomplishments of the compliance program as well as providing strategies/recommendations for compliance program improvements.
Develop and review written policies and procedures related to the design and operation of the ACO compliance program including the standards of conduct/code of conduct.
Review effective mechanisms for identifying and addressing compliance problems related to the ACO’s operations and performance.
Review effectiveness of established mechanisms for ACO employees, contractors, participants, providers / suppliers, and others to anonymously report suspected problems to the compliance officer.
Develop, provide and / or review the effectiveness of compliance training for the ACO, its participants, and providers / suppliers.
Review auditing and monitoring protocols, work plans and reports.