Tiptastic Tuesday: 5 Changes To Help Medicare ACOs Thrive

In order for the Medicare Shared Savings Program to reach its full potential, some key changes must be made, according to the authors in a recent Health Affairs blog post. Medicare ACOs have made progress on care quality and patient experience, however, only 1 in 4 MSSP ACOs have cut spending enough to share in overall savings.

According to authors in Health Affairs, the Medicare Shared Savings Program needs to make the following changes to truly thrive:

  • Increased certainty: A major issue with MSSPs is uncertainty. In order to correct this, CMS should transition to a benchmark calculation formula that combines ACOs’ historical spending and regional spending to eventually transition to a benchmark based completely on regional spending.
  • Clear definition of the transition away from fee-for-service: CMS should drive the transition with incentives greater than those for fee-for-service for organizations that demonstrate reduced costs and improved quality.
  • Alignment of MSSP with other Medicare reimbursement programs: In order to get MSSP and other Medicare alternative payment models on the same page, the authors recommend risk adjustment calculations, reporting mechanisms and requirements, and consistent quality measures.
  • Patient engagement: ACOs need more support to communicate and engage with their patients. The authors suggest expanding CMS’ pilot program for Pioneer ACOs’ “attestation models.”
  • Use of pointers from commercial ACOs: Many ACOs in the private sector have seen more success than those under Medicare by shifting away from fee-for-service with limited financial risk. CMS “should seek to reinforce those successful steps.”

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HMS ACO Blog Series Part VI: Shared Savings & ACOs

Eligible providers, hospitals and suppliers may participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). The Centers for Medicare & Medicaid Services (CMS) has established a Medicare Shared Savings Program to facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs.

The Shared Savings Program is designed to improve beneficiary outcomes and increase value of care by:

  • Promoting accountability for the care of Medicare FFS beneficiaries
  • Requiring coordinated care for all services provided under Medicare FFS
  • Encouraging investment in infrastructure and redesigned care processes

The Shared Savings Program rewards ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting patients first.

HMS ACO Blog Series Part III:The Pioneer ACO Model

The Pioneer Accountable Care Organization Model (ACO) is designed for health care organizations and providers that are already experienced in coordinating care for patients across care settings. It will allow these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Services Program. And it is designed to work in coordination with private payers by aligning provider incentives, which will improve quality and health outcomes for patients across the ACO, and achieve cost savings for Medicare, employers and patients.

Nationwide, there are 32 ACOs participating in the Pioneer ACO Model. Click here to find one near you.

HMS ACO Blog Series Part II: The Advanced Payment Model

The Advanced Payment Model Accountable Care Organization (ACO) is designed for physician-based and rural providers who have come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Through the Advance Payment Model, selected participants will receive upfront and monthly payments, which they can use to make important investments in their care coordination infrastructure.

There are currently 35 ACOs participating in the Advance Payment Model nationwide. Click here to find one near you.

HMS ACO Blog Series Part I: What Is An ACO?

The Centers for Medicare & Medicaid Services (CMS) defines an Accountable Care Organization (ACO) as an organization of health care providers that agree to be accountable for the quality, cost and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.  The Patient Protection & Affordable Care Act (PPACA) calls for ACOs to agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.

ACOs bring together different parts of care for the patient – primary care, specialists, hospitals, home health care, etc. and ensures all of the parts work well together. ACOs may use a range of payment models ( capitation, fee-for-service, shared savings, etc) and is accountable to the patients and the third-party payer for the quality, appropriateness and efficiency of the health care provided.

Click here to read the ACO final rule and stay tuned to the HMS blog as we explore ACOs in our latest blog series.  Upcoming posts include the difference between an ACO and a Medical Home, Advanced Payment ACOs, Pioneer ACOs and more!  

More Than Half Of U.S Residents Have Access To ACOs

According to a recent report by consulting firm Oliver Wyman, more than half of the U.S. population lives in areas served by Accountable Care Organizations (ACOs), which reward doctors and hospitals for working together to improve quality and to control costs.

Currently, 52% of U.S. patients live in primary care service areas served by ACOs up from 45% last August.  Additionally, at least 28% of U.S. patients live in areas served by two or more ACOs.

Click here to read more.