Numerous Accountable Care Organizations to Take On Greater Financial Risk With Next Generation Model
The Centers for Medicare and Medicaid Services (CMS) announced that 21 health care organizations have enrolled in its newest model of Accountable Care Organization (ACO). The Next Generation model is ideal for ACOs that are prepared to maximize value-based care as it allows for greater or even total financial risk, thus allowing for a greater share in savings, according to a recent article on MedPage Today.
Since its inception in 2012, the ACO initiative has sought to bring together health care providers within a community to coordinate services for Medicare patients with the purpose of providing high quality care while minimizing unnecessary costs and redundant services. Earlier models provided by CMS include the Medicare Shared Savings Program and the Pioneer ACO Program. The Shared Savings Program is the more conservative option, offering a shared-savings-only track and retrospective reconciliation. The Pioneer Program was conceived as a more developed version, offering ACOs the opportunity to take on more risk and choose either a prospective or retrospective option. Next Generation furthers this development by exclusively offering a prospectively set benchmark of cost-savings and allowing for greater financial risk and more shared savings than either of the previous 2 models.
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In addition to these innovations, CMS told MedPage Today that the Next Generation model is unique in that it “...allows beneficiaries to choose to be aligned to the ACO, and tests beneficiary incentives for seeking care at Next Generation providers, including increased availability of telehealth and care coordination services."
CMS continues to evaluate and innovate the older ACO models, as evinced by its development of the new ACO Investment Model under the Shared Savings Program. This program will offer pre-paid shared savings to new ACOs in under-served locations, as well as encourage current ACOs to transition to higher risk models.
With 121 new organizations signed up and with new initiatives, including the most progressive ACO model to date, it is likely that this year CMS will be able to build upon the $411 million in savings it charted in 2014.—Katie Grosso
Reference
Frieden J. 21 health organizations join next gen of ACOs. MedPage Today. January 11, 2016.
