12 Organizations Demand CMS Advance Next Generation ACO Care
By - Leading healthcare organizations are actively demanding the Centers for Medicare & Medicaid Services (CMS) step up its Next Generation Accountable Care Organization (ACO) Model financial game. The National Partnership for Women & Families, the Center for Medicare Advocacy, and the Medicare Rights Center, along with 9 other leading consumer advocacy groups, encourage CMS to ensure that innovative models of care delivery and payment provide thorough, coordinated, and high quality care while keeping costs low.
In a letter addressed to Patrick Conway, MD, MSc, CMS Chief Medical Officer and Deputy Administrator for Innovation & Quality, the twelve advocacy groups urge CMS to guarantee The Next Generation Organization ACO Model resultantly manifests high quality, well-coordinated care. The model give CMS an imperative chance to advance approaches to payment reform that profoundly revitalize the delivery of care, the advocacy groups state.
“Next Generation ACOs should deliver high quality, high value care that treats the patient as a whole person and ensures coordination of care, improved communication, patient support and empowerment, and ready access to health care providers, services and community-based resources and supports,” the letter to Conway states. “We believe that the most successful ACOs will be grounded in comprehensive and well-coordinated primary care – a truly patient-centered medical home. As CMS evaluates Next Generation ACO applicants and considers future evolution of the program, these core elements must be a driving force,” the consumer advocacy groups maintain.
ACOs represent a favorable archetype for strengthening healthcare’s overall quality, shrinking expenses, and advancing the overall patient experience of care through the trifold alignment of payment with value, quality, and a focus on community-based coordinated care, the groups additionally maintain. The aforementioned Next Generation ACO recommendations are vital, because they shine a needed spotlight upon both beneficiaries and family caregivers with care design and delivery as a secondary focal point, the groups explain.
“We urge CMS to consider the quality component of the discount that will be applied to a Next Generation ACO's benchmark. We are concerned that the financial effects of quality appear to be much lower in the Next Generation program than in other CMS accountable care programs. We recommend that CMS increase the financial effects of quality to be more consequential,” the letter to Conway maintains.
Next Generation ACOs allow ACOs to assume greater levels of risk and responsibility outside the confines of Fee-For-Service Medicare, the Medicare Shared Savings Program, or Pioneer ACOs, the letter says. “As CMS continues to develop new models of care and payment and providers take on increased risk, reward, and responsibility, it is important that CMS ensure that the evolution and application of consumer protections are keeping pace,” the groups assert. “We therefore urge CMS to clarify how consumer protections will be enhanced as the level of risk that ACOs may assume increases.”
Additionally, the letter presses for enhanced levels of financial transparency. “Patients who are concerned about the provider’s decision should have access to a process to seek a second opinion, within or outside of the ACO, which does not cause them to incur additional cost sharing,” the groups confirm. “The ACO appeals process should be robust and designed to address the unusual context of an ACO – where the patient’s treating physician may have a direct financial relationship with the ACO and its participating providers.”
The letter is essential to advance the financial rewards proposed in CMS’ Next Generation ACO Model Request for Applications, confirms one of the signees, The National Partnership for Women & Families.
“Any use of financial incentives must be limited to and focused on removing barriers to care, building strong relationships between providers and beneficiaries, and engaging patients in their care,” the letter to Conway explains. “Waiving or reducing copays for office visits to ACO providers or for medications related to chronic care management may have potential to improve beneficiary access to care by removing financial barriers,” the group add.
Additionally, the dozen signees confirm they do not think the presently proposed semi-annual monetary reward will meet or exceed their collective objectives of strengthened patient-provider relationships and enhanced patient engagement.
It is hopeful needed change within the future of Next Generation ACO efforts will advance the financial realm of the healthcare industry. As a candidly semi-related concluding nod to Leonard Nimroy’s famous words from Star Trek: The Next Generation allege, “Change is the essential process of all existence.”
