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What is an ACO?

An Accountable Care Organization (ACO) is a group of doctors and other healthcare providers who agree to work together with Medicare to give you the best possible care.

ACOs may take different approaches to giving you coordinated care. Some ACOs may have special nurses that help you set up appointments or make sure your medications are in order when you enter or leave a hospital. Other ACOs may help your doctors get you equipment for monitoring your medical conditions better at home, if you need it. Most ACOs use advanced systems that let them more carefully track your care, and make sure your doctor has the most up-to-date information about your health.

The goal of the ACO is to support your doctor in caring for you. ACOs help your doctor and healthcare providers work together more closely, by making sure they have the most up-to-date information about your health and your care. For you, this means your doctors communicate better with each other, and you avoid having duplicate tests or answering the same questions over and over. Working together, your doctors can do more to follow your health, make sure you get the best possible care, and may hire additional staff to help meet your unique care needs, depending on what works best for you.

Doctors and other healthcare providers choose to participate in an ACO because they’re committed to your care experience. They may also be rewarded for offering you better, more coordinated care. If your physician is part of the Indiana Lakes ACO, you will be notified, either in person at your next office visit or by letter.

An ACO isn’t the same as a Medicare Advantage Plan or Health Maintenance Organization (HMO). You’re still in Original Medicare, and your Medicare benefits, services, rights and protections won’t change. And you still have the right to use any doctor or hospital that accepts Medicare at any time, the same way you do now.

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Frequently Asked Questions:

How do I know my doctor is in the Indiana Lakes ACO?

ACOs must provide in-office notification of the provider’s participation in the ACO in settings in which the beneficiary receives primary care services. In addition to this, Indiana Lakes ACO has mailed information to those Medicare Fee-for-Service patients whose doctors and/or other healthcare providers are participating in the Indiana Lakes ACO.

If I have not been notified that my doctor is in the ACO, what do I need to do?

You don’t need to do anything. You’ll still be in Original Medicare, and you’ll still have the right to use any doctor or hospital that accepts Medicare, at any time.

Do I have to participate in the Indiana Lakes ACO?

You still have the right to see any doctor or hospital that accepts Medicare, at any time.

You can continue receiving care from your doctor, or you can choose to see a doctor who doesn’t participate in an ACO. It is your choice.

Can I still see all of my regular Medicare doctors and healthcare providers?

It’s important to know that:

  • You are still in Original Medicare.
  • You are still entitled to all the same Medicare services, benefits, and protections.
  • You can still go to any doctor, hospital, or other provider that accepts Medicare. Nobody can restrict which providers you see.

Can I still choose to receive services from any new doctor, hospital or healthcare provider that I want to?

You can still choose to go to any doctor, hospital, or other healthcare provider that accepts Medicare. Nobody – not even your current physician – can prevent you from seeing the doctors, hospitals or providers you want.

What information about me will the Indiana Lakes ACO have access to?

To help doctors who participate in an ACO give Medicare Fee-for-Service patients like you high quality care, Medicare wants to share some additional information about your care with them. This information includes things like doctor, hospital, and pharmacy visits in the past and moving forward. This information helps your doctor, and the other ACO providers, track the services you’ve already received, understand where you may need more care, and find ways to smooth the path for you if you have to transfer in or out of a hospital, or from the care of one doctor to another. If you decide you do not want to have the information about your care shared with the ACO, you can do so.

How can I decline to have my personal health information shared?

We value your privacy, so it’s important to know that you can prevent Medicare from sharing this information at any time.

  • Call (800) MEDICARE (800-663-4227). TTY users should call (877) 486-2048 and tell the operator you are calling to tell Medicare that you do not want your information shared with any ACO.

Also, Medicare will not share any information about alcohol and drug treatment history, if you have received such treatment.

After your form or phone call is received, Medicare will update its records to show that you do not want to have your data shared. If you call (800) MEDICARE, you will receive a letter confirming this change. It will take about 45 days for this change to take effect.

What if I change my mind and decide that I do want my personal health information shared in the future?

If you change your mind in the future, you can call (800) MEDICARE (800-663-4227) and tell them that you have changed you mind and that you do want your data shared. You will receive a letter confirming this change.

What if I have received alcohol and drug treatment, will that information be shared with the Indiana Lakes ACO?

To help you receive high quality care, Medicare shares general health information with the participating ACO, in this case your Indiana Lakes ACO physician. However, to protect your privacy, Medicare doesn’t share any information about treatment a Medicare Fee-for-Service patient received for alcohol and drug treatment with a participating ACO.

How long do I have to respond to say that I do not want my personal health information shared with the participating ACO?

Medicare values your privacy. For that reason, you can prevent Medicare from sharing your personal health information, or otherwise change any of your preferences, at any time.

Just call (800) MEDICARE (800-663-4227), and they can help you set your preferences the way you want them. You can also return the “Declining to Share Personal Health Information Form” to our doctor’s office.

I recently enrolled in a Medicare Advantage Plan but I also received a notice that my physician is part of the Indiana Lakes ACO, does that change anything?

Because you chose to enroll in a Medicare Advantage Plan, the notice you received about Accountable Care Organizations (ACOs) is no longer accurate. Please disregard it.

What if I am already happy with my care the way it is?

We’re glad you’re having a positive experience already. You can continue to see you doctor the way you have been. Your doctor’s participation in an ACO won’t change your benefits in any way, and decisions about your care stay with you and your doctor.

How will being in an ACO help my doctor?

Doctors participating in ACOs may have improved access to the expertise, staff, and technology they need to make sure your care is coordinated across all the places you get services. For you, this coordination could mean less paperwork to fill out at the doctor’s office, avoiding unnecessary tests, or more help for you in dealing with any health conditions.

Your doctor’s office sent me a letter, what do I need to do?

You do not need to take any additional steps to continue to receive care from your usual healthcare team. You’ll still be in Original Medicare, and you’ll still have the right to use any doctor or hospital that accepts Medicare, at any time.

I received a letter that my doctor is participating in the Indiana Lakes ACO.  What are the forms included in this letter? Do I have to fill them out?

It’s important to know that your doctor, not you, is participating in an Accountable Care Organization (ACO). You don’t have to fill out any forms or take any action to keep seeing him or her. 

The letter you got should include a form “Declining to Share Personal Health Information,” To help give you improved care, Medicare would like to share information about visits you made to doctors, hospitals, or pharmacies. This information can help your doctor and other healthcare providers give you the best possible care.

You can choose to prevent Medicare from sharing this information by either by calling 1-800 Medicare; or completing the form you got and returning it to your doctor’s office.  You should fill this form out ONLY if you don’t want Medicare to share information.  

Can I receive a written translation of the letter I received from my doctor?

For Spanish speaking patients, (800) MEDICARE (800-663-4227) can provide both a written version and verbal translation of this letter. For assistance in translating the letter to another language, (800) MEDICARE (800-663-4227) cannot provide you with a written version of the letter at this time. Please know that you can always call (800) MEDICARE (800-663-4227) to get the information verbally, over the phone.

My relative received a letter from the Indiana Lakes ACO, but they passed away recently, what do I need to do?

We are sorry to hear about your loss. These letters were sent because of your relative’s history of receiving care from their physician who is participating in the Indiana Lakes ACO. You don’t need to do anything further – over time your relative will be removed from the list of patients affiliated with the participating physician.


Indiana Lakes ACO, INC.

Name and Location:

  • Indiana Lakes Accountable Care Organization, Inc., 200 High Park Avenue, Goshen, Indiana 46526

Primary Contact:

  • Bruce McDonald
    bmcdonald@goshenhealth.com
    (574) 364-2564

Composition of ACO:

A joint venture between the hospital and ACO professionals.

Indiana Lakes ACO, Inc.’s Participants:

        • Alan Bierlein, MD
        • Elkhart Emergency Physicians
        • Gerig Surgical Associates, PC
        • Goshen Family Physicians
        • Goshen Medical Practice
        • Jeffrey Bolduan, MD
        • Krabill Family Medicine
        • Kuhn Medical Clinic, LLC
        • Goshen Team:Bariatrics
        • Goshen Retreat Women's Health Center
        • Goshen Center for Cancer Care
        • Goshen Wound Center
        • Goshen Hospital
        • Goshen Heart & Vascular
        • Physicians (offices identified below)
          • Goshen Physicians Family Medicine | Elkhart
          • Goshen Physicians Family Medicine | Keystone
          • Goshen Physicians Family Medicine | Ligonier
          • Goshen Physicians Family Medicine | Lincoln Avenue
          • Goshen Physicians Family Medicine | Middlebury
          • Goshen Physicians Family Medicine | Milford
          • Goshen Physicians Family Medicine | New Paris
          • Goshen Physicians Family Medicine | Pro Park
          • Goshen Physicians Family Medicine | Shipshewana
          • Goshen Physicians Family Medicine | Syracuse
          • Goshen Physicians Osteopathic Family Clinic | Nappanee
          • Goshen Physicians Gastroenterology
          • Goshen Physicians Internal Medicine
          • Goshen Physicians Multispecialty Clinic
          • Goshen Physicians Neurology
          • Goshen Physicians OB/GYN
          • Goshen Physicians Orthopedics & Sports Medicine
          • Goshen Physicians Pain Management
          • Goshen Physicians Pediatrics
        • Maple City Health Care Center
        • P. Rao Betina, MD, FCCP
        • Paul Buller, MD
        • Radiology, Inc
        • Sleep & Snooze Clinic
        • Urology Associates of Elkhart, Inc

 

Indiana Lakes ACO, Inc.’s Board of Directors:

  • Max Mertz, MD, Chairperson, Voting Member, ACO Participant, Goshen Physicians
  • Jeffrey Bolduan, MD, Voting Member, ACO Participant, Jeffrey Bolduan, MD
  • Larry Allen, MD, Voting Member, Goshen Physicians
  • John Dick, MD, Voting Member, Milford Family Physicians, LLP
  • Ben Nelson, MD, Voting Member, Goshen Physicians
  • Nathanial Dew, MD, Voting Member, Gerig Surgical Associates
  • Barbara Meyer, MD, Voting Member, Goshen Family Physicians
  • Tony Pechin, MD, Voting Member, Goshen Physicians
  • Jody Neer, MD, Voting Member, Goshen Physicians
  • Randall Cammenga, MD, Voting Member, Goshen Hospital
  • Randy Christophel, Voting Member, Goshen Hospital
  • Amy Floria, Voting Member, Goshen Hospital
  • Lou Ann Good, Voting Member, Medicare Beneficiary Representative

 

Indiana Lakes ACO, Inc.’s Committees:

  • Finance & Savings Distribution Committee
    • Larry Allen, M.D. (Chairman)
  • Patient Centered Medical Home Committee
    • Tony Pechin, M.D. (Chairman)
  • Communications & Marketing Committee
    • Bruce McDonald (Chairman)
  • Medical Management & Quality Committee
    • Max Mertz, M.D. (Chairman)

Indiana Lakes ACO’s Officers:

  • Larry Allen, M.D., Chief Executive Officer & Chief Medical Officer
  • Amy Floria, Chief Financial Officer
  • Max Mertz, M.D., Medical Director of Quality Improvement
  • Alan Weldy, Chief Compliance Officer
  • Derek Empie, General Counsel
  • Bruce McDonald, Chief Operational Officer

Information Related to Indiana Lakes ACO, Inc.’s Qualification for Medicare Shared Savings Program Pre-Participation and Participation Waivers:

The Board of Directors for Indiana Lakes ACO, Inc. has approved execution of a Memorandum of Understanding Regarding Contribution of Support Services with Goshen Hospital and Indiana Lakes Managed Care Organization. In order to assist Indiana Lakes ACO in its pursuit of the Medicare Shared Savings Program’s three-part aim of (1) improved care for individuals, (2) improved health for populations, and (3) lower growth in Medicare Parts A and B expenditures, Goshen Hospital and Indiana Lakes Managed Care Organization have agreed to provide certain support services to Indiana Lakes ACO for start up and ongoing operations of Indiana Lakes ACO. The support services include:

  • Personnel resources
  • Information technology resources
  • Patient communication media, including patient notifications, printings and mailings, website development, call center training, Service Excellence training, and facilities signage

INDIANA LAKES ACO SHARED SAVINGS

Amount of shared savings/losses:

  • Agreement period beginning 2013, Performance Year 1: $0, Agreement period beginning 2013, Performance Year 2014: $0, and “Agreement period beginning 2013, Performance Year 2015: $0

Shared Savings Distribution

Agreement period beginning 2013, Performance Year 1: $0, Agreement period beginning 2013, Performance Year 2014: $0, and Agreement period beginning 2013, Performance Year 2015: $0

Accountable Care Organization Quality Performance Report »