Provider Advocates Welcome New ACO Option

Note: iProtean Connect will take a break next week because of the iProtean Symposium at The Lodge at Torrey Pines in La Jolla, CA.


The Centers for Medicare and Medicaid Services (CMS) recently provided more information on its “Next Generation of ACO Model,” an initiative for accountable care organizations (ACOs) that are experienced in coordinating care for populations of patients.


The goal of the Model is to test whether strong financial incentives for ACOs, along with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for original Medicare fee-for-service beneficiaries. (“New Medicare ACO Option Offered,” HFMA Weekly, March 13, 2015)


CMS wrote in its recent press release that the Next Generation ACO Model has strong patient protections to ensure that patients have access to and receive high-quality care. It will be evaluated (as other Medicare ACO initiatives) on its ability to deliver better care for individuals, better health for populations and lower growth in expenditures. CMS will publicly report the performance of the Next Generation Pioneer ACOs on quality metrics, including patient experience ratings, on its website.


CMS expects approximately 15 to 20 ACOs from a variety of provider organization types and geographic regions to participate in the Next Generation ACO Model. The Model will consist of three initial performance years and two optional one-year extensions. (Next Generation ACO Model, CMS)


The model includes a voluntary participation component for Medicare enrollees, and allows providers experienced in coordinating care for populations of patients to assume greater amounts of financial risk and reward than in the existing Pioneer or Medicare Shared Savings Program (MSSP) ACOs.


Key features include:

  • Refining benchmarking to reward both achievement and improvement in cost containment, ultimately transitioning away from comparisons to an ACO’s historical expenditures
  • Offering a selection of payment mechanisms to enable a graduation from fee-for-service payments to capitation


New features for beneficiaries include:

  • Access to home visits, telehealth services and skilled nursing facilities
  • Opportunities to receive a reward payment for receiving care within the ACO
  • A process to allow beneficiaries to confirm their care relationship with ACO providers


A Healthcare Financial Management executive noted that many of the features in the Next Generation ACO Model “appear designed to address existing challenges encountered by providers in the MSSP and Pioneer models.” (“New Medicare ACO Option Offered,” HFMA Weekly, March 13, 2015)


Another expert from Premier, a provider alliance, noted that the additional ACO option would enable the market to mature and evolve.


Medicare providers can apply for the Next Generation ACO Model through two rounds of applications in 2015 and 2016.




iProtean subscribers, the new advanced new advanced Governance course, Two Imperatives for Boards, featuring Tom Dolan, Ph.D. and Karma Bass, MPH, FACHE of Via Healthcare Consulting will be in your library soon. Ms. Bass will be an expert presenter at iProtean’s upcoming symposium.



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