MSSP ACO Archives · mTelehealth

Next Generation ACO Model Select

Dr. M Telehealth — Mon, 08 Oct 2018 15:23:18 +0000

Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program (Shared Savings Program), the Next Generation ACO Model offers a new opportunity in accountable care—one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.

Select anywhere on the map below to view the interactive version

There are 51 ACOs participating in the Next Generation ACO Model. (List)

To view an interactive map of this Model, visit the Where Innovation is Happening page. Read more about

If you are a Medicare beneficiary seeking information about this model, please review the section below titled I’m a Medicare Beneficiary, so what does this mean for me?

Background

Medicare ACOs are comprised of groups of doctors, hospitals, and other health care providers and suppliers who come together voluntarily to provide coordinated, high-quality care at lower costs to their Original Medicare patients. ACOs are patient-centered organizations where the patient and providers are true partners in care decisions. Medicare beneficiaries will have better control over their health care, and providers will have better information about their patients’ medical history and better relationships with patients’ other providers. Provider participation in ACOs is purely voluntary, and participating patients will see no change in their Original Medicare benefits and will keep their freedom to see any Medicare provider. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

Model Details

The Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients. It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP). The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.

Included in the Next Generation ACO Model are strong patient protections to ensure that patients have access to and receive high-quality care. Like other Medicare ACO initiatives, this Model will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures. This is in accordance with the Department of Health and Human Services’ “Better, Smarter, Healthier” approach to improving our nation’s health care and setting clear, measurable goals and a timeline to move the Medicare program — and the health care system at large — toward paying providers based on the quality rather than the quantity of care they provide to patients. In addition, CMS will publicly report the performance of the Next Generation Pioneer ACOs on quality metrics, including patient experience ratings, on its website.

Quality and financial results are provided for Performance Year 1 (2016):

Performance Year 1 (2016) (XPS)

The Model will consist of three initial performance years and two optional one-year extensions. Specific eligibility criteria are outlined in the Request for Applications (PDF). Questions regarding the Next Generation ACO Model can be directed to NextGenerationACOModel@cms.hhs.gov.

Additional Information

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Accountable care organizations: Time to make risk-adjustment more stable

Dr. M Telehealth — Mon, 08 Oct 2018 15:19:11 +0000

ACO stakeholders ask CMS to keep upside-only risk model, while 29 others from Next Gen ACO Coalition want to make risk more predictable.

Susan Morse, Senior Editor

Two interesting developments happened on Thursday that could impact the future of Accountable Care Organizations and the amount of risk they manage.

First, 29 of the 51 Next Generation ACOs announced a new coalition to advocate for stabilizing the risk-based model to the Centers for Medicare and Medicare Services.

In a second but separate ACO move on the same day, nine healthcare organizations, including America’s Health Insurance Plans, America’s Essential Hospitals and the American Medical Association, wrote to the Centers for Medicare and Medicaid Services in support of the upside-only risk model of the Medicare Shared Savings Program.

ACO status check

CMS proposed an overhaul in August that involves scaling back the MSSP ACO model. The rule would limit non-risk to two years instead of six, and decrease the shared savings rate from 50 to 25 percent. The comment period ends October 16.

In response, stakeholders asked CMS to allow more time for ACOs in the shared savings-only model and to return the shared savings rate to at least 50 percent.

What’ more, over 70 percent of ACOs facing mandatory risk said they were likely to leave the program.

“Program changes that deter new entrants would shut off the pipeline of beginner ACOs that should be encouraged to embark on the journey to value,” they wrote.

What ACOs need: Time to realize savings

Avalere in a report released this week, said it took time to achieve savings, more than the two years CMS proposes.

MSSP supporters have said recent data show MSSP ACOs generated $1.1 billion in gross savings to Medicare and netted $314 million.

Other groups in support of MSSP are the Association of American Medical Colleges, the American College of Physicians, Health Care Transformation Task Force, the Medical Group Management Association, the National Association of ACOs and Premier.

Of the 562 total ACOs participating in the Medicare Shared Savings Program, 82 percent take on no financial risk for healthcare cost overruns.

This is unlike Next Gen participants, which take on the most risk.

Next Gen ACO Coalition’s goals

In touting Next Gen savings of $62 million during the 2016 performance year and in the proposed MSSP overhaul, CMS Administrator Seema Verma has made it clear the agency wants ACOs to take on more risk.

Data from Evolent Health shows that ACOs in such two-sided risk models generate the most cost savings, according to research released by the new coalition.

The coalition’s goals are to advocate for a fair and predictable risk-adjustment policy, create predictability in the program, avoid past mid-year and late-year programmatic changes that disrupt financial performance and erode long-term stability, and to preserve and evolve the program.

The Next Gen program, begun in 2016, expires in 2020. Its future is uncertain, according to Mara McDermott, vice president of McDermott+Consulting, who has been working with the Next Gen ACO Coalition.

Short-term there have been some payment changes in Next Gen that have been met with some concern, McDermott said. There’s also a feeling that there could be better coordinated communication.

Next Generation, as the risk model being promoted by CMS, has the potential to shape the healthcare delivery system, McDermott said.

If CMS is headed toward more risk, providers need to be empowered by policy to buy, build or outsource risk-taking capabilities.

Over the long term, the coalition will focus on developing elements of future payment policy, network design, and beneficiary engagement.

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Why 2015 was the best year yet for Medicare ACOs

Rosey Posey — Tue, 06 Sep 2016 01:24:44 +0000

ACO’s Shared Saving financial figures show small changes from 2015 to 2014 HOWEVER, the overall benefits in improving patient outcomes and creating more valuable interaction between patients and providers continues to show great success among ACO groups.

September 6, 2016 by Healthcare Partnerships

CMS just released the 2015 results of its Pioneer and MSSP ACOs, and once again, the picture looks nearly the same as in previous years: around a third of all participants excelled and earned shared savings, while close to half weren’t as lucky and surpassed their spending benchmarks. But behind the raw financial results are new signs that the program is successfully urging providers to develop more quality-driven and cost-effective models of care.

The financial data itself shows very modest improvements compared to the previous year. Total savings for Medicare (from both Pioneer and MSSP models) rose to $466 million, up from $411 million in 2014, and the number of ACOs earning savings rose to 125 from 97, or roughly 31 percent of total participants compared to 27 percent previously. Roughly the same number of ACOs (83 to 89) in 2015 managed to spend less the benchmark without qualifying for bonuses.

While unimpressive taken as whole, performance differences between individual ACOs reveal that in its fourth year, some organizations demonstrated that years of experience in the program may be paying off. Of the ACOs that started in 2012, 42 percent managed to earn shared savings in 2015, as did 37 percent of those launching in 2013, compared to 21 and 20 percent for more recent arrivals. In addition, seven of the year’s top ten highest performers by total savings were ACOs that had participated in the MSSP since 2012 or 2013. Even among the ACOs that exceeded their cost benchmarks, only about 22 percent (42) were longtime MSSP members. 57 percent were first- or second-year ACOs. Most of the top-earning ACOs have not yet publicly commented on the specific reasons for their success so far, though some have in the past cited efforts such as encouraging a competitive spirit between physicians to improve patient outcomes and performance (Palm Beach ACO), prior physician experience with patient-centered medical homes and care coordination among nurses for high-risk patients (Hackensack Alliance), and a strong foundation of patient care data and thorough understanding of a patient population’s health needs (Advocate Physician Partners). The fact older ACOs are performing better suggests that it’s only a matter of time before their successful methods and strategies are adopted by other groups.

The latest ACO results also show patients continue to benefit from improved care quality. While often overlooked in the discussion of Medicare ACOs, quality is one measurement in which ACOs have consistently performed well. In 2015, MSSP ACOs demonstrated improvements in 84 percent of all reported quality measurements, especially in fall-risk screening, depression screening and follow-up, blood pressure screening and follow-up, and pneumonia vaccinations, with improvements of at least 15 percent in each category. Such screenings can significantly reduce spending over the long-term, and the improvements made in 2015 are a promising indicator of the program’s success in the absence of any recent quality comparisons to control groups.

Top 10 MSSP ACOs by Shared Savings Earned, 2015 ($M)

	ACO	City, State	2015 Gross Savings (Losses)	2015 Shared Savings	2014 Gross Savings (Losses)	2014 Shared Savings	MSSP Starting Date
1.	Methodist Herman ACO	Houston, TX	89.1	41.9	52.9	22.7	July 2012
2.	Palm Beach ACO	Palm Springs, FL	76.6	36.8	32.2	14.5	July 2012
3.	Advocate Physician Partners Accountable Care	Rolling Springs, IL	72.7	33.5	-5.3	—	Jul 2012
4.	Millennium ACO	Ft Myers, FL	37.1	17.6	8.0	17.5	Jan 2013
5.	Atlantic ACO	Morristown, NJ	35.5	16.7	-12.9	—	April 2012
6.	Cleveland Clinic ACO	Cleveland, OH	33.9	16.6	—	—	Jan 2015
7.	Hackensack Alliance ACO	Hackensack, NJ	33.5	15.6	6.5	2.8	April 2012
8.	UT Southwestern Accountable Care Network	Dallas, TX	30.0	14.2	6.0	2.9	Jan 2014
9.	Orange Accountable Care of South Florida	Miami Lakes, FL	28.5	13.4	-1.6	—	Jan 2014
10.	RGV ACO Health Providers	Donna TX	21.6	12.6	13.8	7.5	April 2012

ACOs as a whole will likely perform better in future years, thanks to upcoming changes in CMS’ benchmarking system, though not every ACO will immediately benefit. CMS announced in April 2016 that benchmarks will be adjusted to reflect regional rather than national cost averages, giving a more realistic cost goal for ACOs and removing an obstacle currently facing historically high-performing groups. Unfortunately, while the updated system will apply to new applicants starting in 2017 and ACOs who started during or later than 2014, early adopters will not be able to take advantage of the new system until 2019 because CMS determined the transition would be too disruptive. In the meantime, Medicare ACOs will likely improve on the average slowly but steadily over the next few years.

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