The budget deal passed late last week establishes the ACO “Beneficiary Incentive Program,” said by some to motivate beneficiaries to be more engaged in their care.
The program would allow ACOs to pay patients if they make primary-care appointments. The budget agreement also will allow beneficiaries to assign a physician in an ACO as their primary-care provider. (“Budget deal’s changes to Medicare ACO program encourage patient engagement,” Modern Healthcare, February 12, 2018)
Beneficiaries who receive services from Next Generation ACOs get a $25 check from CMS to Medicare patients who get an annual wellness visit. Called the Coordinated Care Reward, it is a precursor to the ACO Beneficiary Incentive Program.
The new program is voluntary and differs from the Coordinated Care Reward because the payment must come from the ACO. The payment can be up to $20. It is also limited to ACOs in two-sided risk tracks, suggesting that both Congress and CMS want ACOs to move to downside risk contracts.
The provision that allows beneficiaries to select a primary-care provider in an ACO will likely increase the opportunity for greater care coordination, according to an expert. An ACO will be able to better understand before the performance year begins which patients are in its population, offering more opportunities to engage with patients on prevention and wellness initiatives. (“Budget deal’s changes to Medicare ACO program encourage patient engagement,” Modern Healthcare, February 12, 2018)
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