Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

CMS Welcomes 58 Next Generation ACO Model Participants in 2018

The Next Generation ACO model will see 14 new and 44 renewing accountable care organizations in 2018, CMS announced.

Next Generation ACO model and accountable care organizations (ACOs)

Source: Xtelligent Media

By Jacqueline LaPointe

- In 2018, the Next Generation ACO model will have a total of 58 participating accountable care organizations (ACOs), up from 45 organizations the previous year, CMS recently announced on the program’s Innovation Center webpage.

The class of 2018 Next Generation ACOs includes 14 new and 44 renewing organizations.

The highest-risk Medicare ACO program has seen significant growth since the program launched in 2016. Only 21 organizations participated in the Next Generation ACO model’s first performance year, with three organizations dropping out of the risk-based model before the performance period ended.

By 2017, the number of participating organizations more than doubled. The Next Generation ACO model gained 28 new participants by the program’s second performance year, bringing the total number to 45 ACOs.

Now, more providers are willing to take on the financial risk associated with the Next Generation ACO model. The model builds on its predecessors, the Medicare Shared Savings Program and Pioneer ACO model, by offering participants financial risk levels of up to 100 percent of shared savings and losses.

The financial risk levels in the model, however, place Next Generation ACOs at the “forefront of redesigning healthcare delivery and payment,” the National Association of ACOs (NAACOS) stated in a press release welcoming the new ACOs.

“The interest and growth in participation in the Next Generation Model shows that ACOs are increasingly driving change and pushing healthcare delivery and payment reform forward in new and innovative ways,” said Clif Gaus, President and CEO of NACCOs. “These ACOs are trailblazers and we congratulate them for their work.”

With the number of providers flocking to the Next Generation ACO model increasing, the expectation to achieve savings under the program is growing. In 2016, about 61 percent of Next Generation ACOs earned shared savings payments for reducing costs below their benchmarks in the first year of the program.

The cost-reducing Next Generation ACOs saved a total of $71 million. They received approximately $58 million in total shared savings payments.

Only seven of the ACOs owed financial losses to CMS in 2016, with the shared losses totaling $23 million. The organizations repaid CMS about $20 million in total.

In sum, the Next Generation ACO program generated net savings of $48.3 million, according to CMS data.

While the Next Generation ACO model could be considered a financial success for CMS, the risk-based ACO program could also be seen as a win in terms of care quality. All 18 ACOs scored 100 percent on the 33 quality measures in the program.

CMS has yet to release data on the Next Generation ACO model’s second performance year, which concluded at the end of 2017.

However, the 45 participating ACOs in 2017 are eligible for additional incentive payments whether they save Medicare money or not. The Next Generation ACO model is considered an Advanced Alternative Payment Model (Advanced APM) under MACRA’s Quality Payment Program. Clinicians who sufficiently participate in the Next Generation ACO model will be eligible to earn an automatic 5 percent incentive payment in 2019 based on their 2017 performance in the model.

2018 Next Generation ACO model participants can also earn maximum incentive payments under the Quality Payment Program’s Advanced APM track in 2020.

For a full list of Next Generation ACO model participants in 2018, click here.

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