PathfinderHealth

Frequently asked questions about PathfinderHealth

How do I find providers participating in the PathfinderHealth Network?

To find providers participating in the PathfinderHealth Network, please see the latest provider roster on our Find a Provider page.

Where can I find additional information about ACOs?

How will an ACO lead to better care for me?

When your health care providers have access to your health information and are better able to share that information with one another, they can give you better, more coordinated care. Each of your health care providers will not only know about the health issues that they have treated, they will have a more complete picture of your health through communicating with your other health care providers.

Who will read my medical information? Will it be protected?

The group of doctors, hospitals, and other health care providers together in the ACO will be able to read your medical records, along with other staff authorized to help coordinate your care.

The privacy and security of your medical information is protected by federal law. Contact your doctor’s office for more information about how they protect your medical information or call 1-800-MEDICARE (1-800-633-4227) 24 hours a day/7days a week. TTY users should call 1-877-486-2048.

What rights do I have if my doctor is in an ACO?

You will continue to receive the same rights enjoyed by all people with Medicare. To help you get the best-coordinated care, Medicare will share information about your medical background with your doctor’s ACO, including medical conditions, prescriptions, and visits to the doctor. This is important to help the ACO keep up with your medical needs and track how well the ACO is doing to keep you healthy and helping you get the right care.

What can I expect if my provider is in an ACO?

Over time, if you see a provider participating in an ACO you may notice that:

  • You don’t have to fill out as many medical forms that ask for the same information
  • The healthcare providers that you see all know what is going on with your health because they communicate with each other

How would I know if my provider participates in an Accountable Care Organization (ACO)?

If your doctor chooses to participate in an ACO, you will be notified.

Or, ask your doctor or healthcare provider if he or she is participating in a Medicare ACO. For general information on ACOs, call 1-800-MEDICARE (1-800-633-4227) 24 hours a day/7 days a week. TTY users should call 1-877-486-2048.

What is a provider network?

A provider network is a group of health care providers, such as physicians, hospitals and related medical experts, who are linked together to improve quality of care for patients. These providers make a commitment to work closely together to coordinate all aspects of a patient’s care, to make care seamless. 

What is the Medicare Shared Savings Program ACO?

The Medicare Shared Savings Program ACO was established through the Affordable Care Act (ACA) to test how effectively the ACO model could improve the quality of care and reduce costs. The Medicare Shared Savings Program ACO is a voluntary program that encourages groups of doctors, hospitals, and other health care providers to come together as an ACO to give coordinated, high-quality care to their Medicare patients. For general questions or additional information about what it means to coordinate care, visit the Medicare website or call 1-800 MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

How many providers are in PathfinderHealth?

More than 500 providers are currently participating in PathfinderHealth.

How many people receive care from providers in PathfinderHealth?

PathfinderHealth is currently responsible for the care of more than 20,000 covered lives in Northern Arizona. These individuals are considered members attributed to PathfinderHealth, meaning they receive care from a PathfinderHealth provider.

How many ACOs can I join?

You can only participate in one Medicare ACO as a Primary-Care Provider. Specialists can join multiple ACOs.

What is the fee to join an ACO?

There is absolutely no cost to join PathfinderHealth.