Which payment model allows patients to seek care outside of the provider group?

The accountable care organization (ACO) model allows patients the flexibility to seek care outside of the provider group. ACOs are designed to enhance care coordination among providers, aiming to improve patient outcomes and reduce costs. Under this model, patients can access a wider network of services, including those outside the ACO, while still encouraging them to utilize in-network providers for enhanced care management.

This flexibility is distinct from other models. For example, in a capitation model, providers are paid a set fee per patient regardless of the number of services provided, which can limit patient choice in specialty care. Similarly, health maintenance organizations (HMOs) typically require patients to use designated providers and obtain referrals for specialists, providing less flexibility for out-of-network care. Exclusive provider organizations (EPOs) also restrict patients to a network of providers for covered services, only allowing out-of-network care in emergencies.

In contrast, the ACO approach aims to balance patient choice with coordinated care, empowering patients to seek necessary services while maintaining the overarching goal of quality improvement and cost reduction.