CAPG Praises Next Generation Accountable Care Organizations
“This is an exciting next step in the evolution of coordinated care in traditional Medicare."
By - The Centers for Medicare & Medicaid Services (CMS) recently selected twenty-one healthcare organizations to participate in a newfangled Next Generation Accountable Care Organization (ACO) model. The 21 participating ACOs have formidable experience coordinating patient care through various initiatives, including the Medicare Shared Savings Program (SSP) and the Pioneer ACO Model, says CMS.
High levels of financial risk are on the table. But the possibility of high-level rewards perhaps makes the revenue cycle risk downright considerable.
There are now 477 ACOs across SSP, the Pioneer ACO Model, the Next Generation ACO Model, and the Comprehensive ESRD Care Model, says CMS.
64 ACOs are in a risk-bearing track, CMS added. Nearly 9 million beneficiaries will be served.
Although the Next Generation model participants take on a higher level of financial risk, they have a greater opportunity to acquire care coordination and care management savings, CMS explains.
“For providers, ACOs hold the promise of realigning the practice of medicine with the ideals of the profession — keeping the focus on patient health and the most appropriate care,” CMS states.
ACOs are based on a patient-centered paradigm. Healthcare providers will have access to better quality information about their patients’ medical history, CMS confirms. Providers will also be able to maintain much stronger relationships with patients’ other healthcare providers.
What is the ACO Next Generation Model’s big picture focus?
CMS describes the Next Generation ACO Model’s 6 core principles as follows:
- Protect Original Medicare beneficiaries’ freedom to seek the services and providers of their choice;
- Engage beneficiaries in their care through benefit enhancements designed to improve the patient experience and reward seeking care from ACOs;
- Create a financial model with long-term sustainability;
- Utilize a prospectively-set benchmark that: (1) rewards quality; (2) rewards both improvement and attainment of efficiency; and (3) ultimately transitions away from an ACO’s recent expenditures when setting and updating the benchmark;
- Mitigate fluctuations in aligned beneficiary populations and respect beneficiary preferences by supplementing a prospective claims-based alignment process with a voluntary process; and
- Smooth ACO cash flow and support investment in care improvement capabilities through alternative payment mechanisms.
“Building up on experience from the Pioneer ACO Model and [Medicare Shared Savings Program], the Next Generation ACO Model offers a new opportunity in accountable care — one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.” CMS’s website states.
CAPG says new cohorts represent an exciting first step
Recent ACO development receives two thumbs up from the California Association of Physician Groups (CAPG) this week, according to a press release.
The participating organizations are “experienced in coordinating care for populations of patients and whose provider groups are ready to assume higher levels of financial risk and reward,” the agency asserted.
“This is an exciting next step in the evolution of coordinated care in traditional Medicare,” stated Donald Crane, CAPG's President and CEO.
“Capitated payment and enhanced beneficiary engagement are key features that CAPG has long called on CMS to adopt."
"We’re pleased to see that the agency will begin testing these new elements of coordinated, accountable care.”
