ACOs — Accountable Care Organizations
A group of doctors, hospitals, and other healthcare providers who voluntarily come together to give coordinated, high-quality care to a defined patient population. The core model ties financial incentives to quality outcomes and total cost of care reduction. ACOs operate under CMS programs (MSSP, ACO REACH) or commercial payer contracts.
14
Primary Modules
8
Key API Integrations
7
Regulatory Requirements
Primary Portal Modules
Population Health Analytics Care Coordination Clinical Risk Pools Financial Providers Patient Auth Compliance Medications Regulatory Alerts Enrollment
Organizational Relationships
▲ Vertical — Reports To (Upward)
- CMS (for Medicare ACO programs)
- Commercial payers (for commercial ACO contracts)
- ACO governing body
▼ Vertical — Oversees (Downward)
- Participating provider groups
- Care management teams
- Preferred post-acute networks
▶ Horizontal — Collaborates With (Peer)
- IPAs/PHOs (organizational substrate)
- Health plans (shared savings contracts)
- FQHCs (community health integration)
- MSOs (administrative support)
- Behavioral health organizations
- SDOH community partners
- HIEs
Key API Integrations
CMS ACO-MS/ACO REACH APIsCCLF Claims Data FeedsFHIR/CCDA Clinical DataHIE Connectivity (Carequality/CommonWell)eCQM Quality SubmissionHCC Risk AdjustmentFHIR SDOH IGs (Gravity Project)Pharmacy Claims (NCPDP)
Regulatory Requirements
- CMS MSSP regulations (42 CFR Part 425)
- Annual CMS quality reporting
- Beneficiary notification requirements
- FTC/DOJ antitrust review
- HIPAA across all entities
- Stark/AKS waivers for ACO programs
- Health equity reporting