January 15, 2016

CMS Announces New ACO Participants

The Centers for Medicare & Medicaid Services (CMS) announced January 11 that 121 more hospitals and other health care facilities have joined Medicare Accountable Care Organization (ACO) initiatives. Participation has increased in new types of ACOs that reward health care facilities for positive patient outcomes and penalize them for substandard results.

According to CMS, with new participants in the Medicare Shared Savings Program (MSSP), the Next Generation ACO Model, Pioneer ACO Model and the Comprehensive End-Stage Renal Disease (ESRD) Care Model, there are now:

  • Nearly 8.9 million beneficiaries served
  • A total of 477 ACOs across MSSP, Pioneer ACO Model, Next Generation ACO Model, and Comprehensive ESRD Care Model, and
  • 64 ACOs that are in a risk-bearing track including MSSP, Pioneer ACO Model, Next Generation ACO Model and Comprehensive ESRD Care Model
“Accountable Care Organizations are improving quality of care and spending dollars more wisely,” said CMS Chief Medical Officer Patrick Conway in the announcement. “These new initiatives place patients at the center of a coordinated care delivery system and give providers the tools to achieve better outcomes.”

Medicare now offers health care services opportunities to participate in the following ACO options:

Pioneer ACO

The Pioneer ACO model is designed for relatively more experienced organizations that are prepared to take on more financial risk than other facilities. The Pioneer Model provides ACOs that are successful in achieving shared savings in the first two years with an opportunity to move into a population-based payment in the third year. The program started with 32 Pioneer ACOs. Now, nine remain because many have transitioned to the MSSP program.

The Medicare Shared Savings Program

The Medicare Shared Savings Program saw increased participation, with 100 new ACOs joining the program and 147 ACOs renewing their contracts as of January 1. ACOs have shown more interest in performance-based risk arrangements, with 22 ACOs now opting to participate in Track 2 or Track 3, which offer higher shared savings and shared loss rates.

The Next Generation ACO Model

The Next Generation ACO Model is a new initiative from the CMS Innovation Center (CMMI) that builds upon experience with the Pioneer ACO Model and the MSSP. Twenty-one ACOs participate in this new model, which allows ACOs to take on more financial risk. While ACOs in this model are at greater financial risk, they also have a greater opportunity to share in more of the model’s savings. Next Generation ACOs receive their budgets prospectively in advance of the performance year enabling them to plan and manage care around their financial targets. The model also allows beneficiaries to choose to be aligned to the ACO and test beneficiary incentives for seeking care at Next Generation ACO providers including the increased availability of telehealth and care coordination services.

ACO Investment Model

Thirty-nine ACOs participate in the ACO Investment Model. It provides pre-paid shared savings to encourage new ACOs to form in rural and underserved geographical areas and to encourage current MSSP ACOs to transition to performance-based risk arrangements. Up-front payments distributed through the ACO Investment Model support ACOs in improving infrastructure and redesigning care processes.

Advanced Payment ACO Model

Through the Advance Payment ACO Model, selected participants in the MSSP program receive advance payments that will be recouped by CMS from the ACO’s future shared savings. The Advance Payment ACO Model was developed to help smaller ACOs with less access to capital participate in the MSSP. Thirty-five ACOs use this model.

Comprehensive End-Stage Renal Disease (ESRD) Care Model

The Comprehensive ESRD Care Model is designed to identify, test and evaluate new ways to improve care for Medicare beneficiaries with end-stage renal disease (ESRD). In the Comprehensive ESRD Care Model, dialysis clinics, nephrologists and other providers join together to create an ESRD Seamless Care Organization (ESCO) to coordinate care for matched beneficiaries. Thirteen ESCOs are accountable for clinical quality outcomes and financial outcomes measured by Medicare Part A and B spending including all expenditures on dialysis services for their aligned ESRD beneficiaries.

For more information on ACOs, click here.