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New Download: Considering the Next Generation ACO Model

Posted by Matthew Smith on Apr 8, 2016 8:52:37 AM

CMS recently launched the first step of the application process for its Next Generation ACO (“NGACO”) Model. The NGACO, CMS’ newest two-sided risk model, accepted 21 organizations for 2016.

Our 7-page PDF document, Considering the Next Generation ACO Model, includes information explaining and highlighting:

  • Model Highlights
  • Risk Arrangements
  • Payment Mechanisms
  • Timelines
  • Our Experience
  • Our ACO Services

To download this document, please click on the button below.

Next Generation ACO

Topics: Download, Next Generation ACO Model, NGACO

MSSP and NGACO Application Windows Quickly Approaching

Posted by Matthew Smith on Apr 6, 2016 11:50:17 AM

CMS recently launched the first step of the application process for its Next Generation ACO (“NGACO”) Model, and next month opens the window to apply for the Medicare Shared Saving Program (“MSSP”) Initiative. The NGACO, CMS’ newest two-sided risk model, accepted 21 organizations for 2016. The MSSP, which also added enhanced risk-based options in 2016, had 100 new ACO participants this year, bringing the total to 434 ACOs at the start of the year. These numbers reinforce CMS’ stated goal to move 30 percent of traditional Medicare fee-for-service payments into alternative value-based payment models by 2016, and 50 percent by 2018.

MSSP: Zero Downside Risk

The MSSP Model was introduced in 2012 as a key component of the Medicare delivery system reform initiatives found in the Affordable Care Act and a new approach in the delivery of health care intended to facilitate coordination among providers to improve the quality of care. Among the primary attractions of the MSSP was the option to participate with zero downside risk, meaning if organizations outspent their target expenditures, they would not be liable to repay the difference to CMS. Through Track 1 there existed only upside, or the ability to share in any savings generated, an appeal that the MSSP Model maintains to this day. This allows organizations to dip their toes in the accountable, value-based waters and develop the infrastructure necessary for future success while still participating in a fee-for-service environment today. And the participating organizations have largely voiced their approval of the program – more than two-thirds renewed their participation when their initial agreement ended in December.

NGACO: Higher Risk/Higher Rewards

While the MSSP Model was the right first step for many organizations beginning their journey towards value-based care, it was in many ways insufficient for more advanced organizations experienced in care management and risk-based contracting. Thus the Next Generation ACO model was born, providing a higher-risk, higher-reward alternative to the MSSP, while simultaneously responding to and improving upon its oft-maligned and challenged predecessor, the Pioneer Model, with a refined attribution process and enhanced benchmarking methodologies. Now organizations can select between two risk options from 80 to 85 percent on the shared savings option all the way to a full-risk opportunity. Now if organizations overspend their benchmark expenditures, they will have to cut CMS a check at the end of the year. This may seem daunting, but many organizations view this as the natural programmatic evolution and that the increased skin in the game can be the push their organization might need to really enact the necessary transformation. In fact, seven of the new NGACO participants came from the MSSP program, demonstrating the interest of existing program participants to advance their risk exposure and opportunity based on their work and success to date.

The NGACO, with its enhanced risk profile, is obviously not for everyone, which explains why only 21 were accepted in the past cycle. As stated above, the NGACO was effectively developed for those organizations with experience in commercial ACOs or with value-based contracts, or that had experienced success in the MSSP and had outgrown the less-lucrative risk arrangement. Accordingly, in addition to the seven MSSP converts to the NGACO program, eight made the transition from the similarly two-sided, but less favorable Pioneer model.

Deadlines Approaching

The good news for organizations wanting to prepare for a value-based future is that the 2017 application windows for both programs are upon us. Organizations contemplating their fit in either initiative can apply for one or both, but need to submit their Notice/Letter of Intent by the respective deadlines to be considered. These submissions are non-binding, so we encourage organizations at all considering participation to file one and then assess their options in the next few months. One caveat is that while organizations can simultaneously apply for both models, they will ultimately only be able to participate in one of the two initiatives.

The NGACO Letter-of-Intent is due May 2, with the MSSP Notice-of-Intent due May 31. Additional key milestones for both models can be found below:

NGACO_Milestones.png

With the continuous innovations of both payment and delivery models, CMS is maintaining its commitment to the transformative shift to value-based care. While that momentum is undeniable, not all organizations are necessarily ready for that transition just yet, particularly in the riskier models. We recommend undergoing a comprehensive (and candid) self and market assessment of your organization’s present situation and evolution in what GEHC Camden Group considers the eight core domains essential for clinical transformation to successfully thrive in a value-based world. A commitment must be demonstrated in the below key operational competencies in order to achieve success in the changing landscape.

Key_operational_competencies.png

CMS has reiterated its commitment to population health with its ongoing development and support of these accountable initiatives. Even more encouraging, CMS has demonstrated a willingness to adapt and improve to encourage participation and collaboration. The strongest healthcare organizations tend to be the ones that are proactive rather than reactive. For organizations that can see what’s coming down the tracks, there may be no better time than now to begin preparing for a value-based future.

Next Generation ACO

Topics: ACO, MSSP, Population Health, CMS, Next Generation ACO Model, MSSP ACO, NGACO

Pioneer ACOs: Pass or Fail, the Model is Here to Stay

Posted by Matthew Smith on May 14, 2015 1:13:38 PM

By Daniel Juberg, Senior Consultant, The Camden Group

aco_logo-gold.pngLove them or hate them, it’s that time of year when America is getting inundated with high-profile, big budget sequels. The Centers for Medicare and Medicaid Services (“CMS”) is getting in on the act with a follow-up and expansion to the controversial Medicare Pioneer Accountable Care Organization ("ACO") program that was launched in 2012. Following the recently released positive results for the program from 2012 to 2013, CMS is declaring the program a success. But then, why did over 40 percent of the Pioneer ACOs drop out of the program in the first place? And just how should healthcare providers react to this expansion news?

Launched in 2012, the Pioneer ACO Model was designed for healthcare organizations and providers who were already experienced in coordinating care for patients across care settings. Through the alignment of provider incentives to improve quality and health outcomes for patients across the ACO, the program aimed to transition more rapidly from a shared savings payment model to a population-based payment model. The Pioneer Model operated on a track that was consistent with the more popular Medicare Shared Savings Program ("MSSP"), but with greater downside risk and greater levels of shared savings for successful performance.

CMS only allowed organizations to participate that it believed to be the most experienced in care coordination and with the highest chance of success. This led to only 32 brave, inaugural ACOs, or “Pioneers,” as CMS’ first batch of participants. Since 2012, 13 of the 32 Pioneer ACOs have left the program, either exiting Medicare accountable care models completely or transitioning to the less lucrative but also “zero risk” MSSP (Track 1). The majority of ACOs who exited the Pioneer program reportedly found it too costly, too risky, or just simply too complex.

Nearly $400 Million in Pioneer ACO Savings 

However CMS recently announced that, in total, the 32 Pioneer ACOs combined for $384 million in savings over the two-year period, an average of $300 in savings per beneficiary annually. This reduction was achieved largely through a population exhibiting lower hospital utilization, incurring fewer tests and procedures, and undergoing more provider follow-ups after being discharged from a hospital. These positive results have expedited CMS’ stamp of approval for expansion to a larger population of beneficiaries.

What remains unclear is exactly how these ACOs achieved the results and how to establish a more sustainable model (the ACOs saved substantially more in 2012 than in 2013 - $280 million vs. $105 million). But what is clear is CMS’ intent with their latest exuberant declaration: ACOs and population-based payment models are here to stay.

The first wave of CMS’ commitment to promoting the shift in payment methodologies was with the proposed new Track 3 through its MSSP. CMS is currently inserting the design elements from the Pioneer ACO model into the proposed Track 3. Traditionally ACOs participating in the MSSP had two risk arrangement options: Track 1, which presented no downside risk but a lower shared savings rate; and Track 2, which offered a greater shared savings rate but came with the burden of shared losses as well. The proposed Track 3 offers a higher maximum shared savings rate in exchange for accepting greater downside risk. Track 3 proposes a shared savings rate up to 75 percent based on quality, 15 percent higher than in Track 2. However, under Track 3, the ACO’s proposed shared loss rate ranges from 40 to 75 percent based on quality.

Next Generation ACO Model

CMS also recently unveiled the Next Generation ACO model, which offers financial arrangements with higher levels of risk and reward than current Medicare initiatives. This model is an attempt to correct perceived shortcomings of the original Pioneer model with refined benchmarking methodology and improved benefit enhancement tools to help ACOs improve engagement with beneficiaries. With offerings including a selection of payment mechanisms to enable a graduation from fee-for-service reimbursements to capitation, the Next Generation ACO model is similarly targeted at seasoned care management organizations. Again, the message from CMS regarding Track 3 and the Next Generation ACO is clear – only the most experienced in care coordination need apply.

CMS is in the process of evaluating further expansion options based on the positive Pioneer results. So what can healthcare providers, hospitals, and health systems take away from these performance results and announcements in the meantime? By now it is unmistakable that CMS is committed to the shift towards population-based models using the current shared savings arrangements as a conduit. Healthcare providers and organizations need to develop a strategy on where and how they enter into the path to value-based payments. The question no longer is if, but when.

Not for the Faint of Heart

Only the most experienced organizations are prepared to try their hand at the lucrative (yet aggressive) Track 3 or the Next Generation ACO; as we saw with the early Pioneer entries, many of those will fail. But there are plenty of other entry points for organizations to dip their toes into the accountable care and value-based payment waters. The most closely aligned initiative of course is through Track 1 of the MSSP, which offers no downside risk to participants through the first three years of the program. Track 1 allows organizations to build the infrastructure necessary to coordinate care and manage a population with little financial risk. Organizations can simultaneously recruit, refine, and strengthen their clinically integrated networks without being on the hook to CMS financially should they endure growing pains and overspend their benchmark expenditure for the year.

CMS has set a target for 50 percent of Medicare payments to be shared savings or population health payment models by 2018. Organizations need to ask themselves if they are putting themselves in the optimal position to survive and thrive as the landscape shifts to these alternative payment models.

Will you have the infrastructure, care management protocols, and network to support the transformative shift to value-based care? Evaluate your market. Are there opportunities to collaborate? What are your competitors doing? Are payers approaching your market with value-based contracts? Now is the time to discuss and strategize how your organization will adapt to the evolving payer environment and whether participating in one of CMS’ Shared Savings Programs can act as the impetus for change to propel your organization to future success.

CMS has made it clear that ACOs and alternative payment models are here to stay. What’s becoming unclear is whether organizations that don’t successfully prepare themselves for that reality will be as well.


juberg.png

Mr. Juberg is a senior consultant with The Camden Group and focuses on clinical integration, transactions, and strategic and business planning for healthcare organizations. He has extensive experience with the development of ACOs (financial planning and funds flow modeling), managing Medicare Shared Savings Program applications, and implementing clinically integrated networks. He is also experienced in master facility planning, CMMI Innovation Center grants, medical group valuations, and community needs projections. He may be reached at djuberg@thecamdengroup.com or 310-320-3990.

Topics: MSSP, Accountable Care Organization, CMS, Pioneer Accountable Care Organization, Next Generation ACO Model, Daniel Juberg

Reminder: Upcoming Next Generation ACO and MSSP ACO Webinars

Posted by Matthew Smith on Apr 16, 2015 5:09:57 PM

webinar_Clouds_icon-resized-600As a reminder, The Camden Group's Next Generation ACO webinar will be held tomorrow, April 17 at 12:00 p.m. ET. If you have not registered for this event and wish to do so, please register via the green button contained in the blog post. Registration remains open for next week's MSSP ACO webinar as well. Please click the "Read More" link, below, to access the full blog post.

The implementation of the new Next Generation Accountable Care Organization (“NGACO”) model for Medicare has made it increasingly clear that ACOs will be a significant part of the government’s commitment to tie 30 percent of traditional Medicare payments to quality or value through alternative payment models by the end of 2016, and 50 percent of payments to these models by the end of 2018.

Whether your organization is just beginning to think about taking steps toward accountable care and considering the Medicare Shared Savings Program (“MSSP”); or if your organization has advanced to the point of considering the NGACO model, The Camden Group’s complimentary webinar series will provide you with background information on the programs to help you make an educated decision as to whether to participate, when to participate and which program is right for your organization.

Join us on Friday, April 17 at 12:00 p.m. ET for the first webinar in the series focusing on the NGACO program. We will discuss the specifics of this new model and the skills needed for a successful launch. Topics will include:

  • An overview of the NGACO model and the key differences between other CMS programs
  • Types of prior experience will be important for success in the NGACO
  • The included alternative payment mechanisms, and unique opportunities for network alignment
  • Next steps and logistics to consider before applying

To register for the NGACO webinar, please click the button below:

NGACO Webinar, Webinar, The Camden Group, Next Generation ACO, Accountable Care Organization

Our MSSP program will be held on Thursday, April 23 at 12:00 p.m. ET. Based on our previous application cycle and operational experience, we will discuss the specifics of the MSSP model and important items for consideration in determining if the time is right for your organization to apply. Topics will include:

  • An overview of the MSSP model and the key differences from other CMS programs
  • The changing value-based landscape and where the MSSP model fits
  • Considerations for leaders evaluating the MSSP program opportunity
  • Key elements and logistics to contemplate before applying*

*The Notice of Intent to apply is non-binding and does not commit an organization to applying. 

To register for the MSSP webinar, please click the button below:

MSSP Webinar, Webinar, The Camden Group, Accountable Care Organization

 

 

 

Our expert facilitators for the webinars include:

bosko_backgroundTawnya Bosko | Ms. Bosko is a senior manager with The Camden Group and specializes in designing and implementing clinical integration, high growth medical service operations (“MSO”) and finance, physician hospital organization (“PHO”) and MSO development, managed care strategy, and physician alignment.

 

 

glaserMishka Glaser | Ms. Glaser is a manager with The Camden Group, specializing in clinical integration, accountable care, and many other innovation strategies. She brings over 15 years of experience in various sectors of healthcare including physician practices, insurance, and pharmaceuticals. Ms. Glaser’s in-depth knowledge of value-based care operations provides a context for assisting clients in navigating population health.

 

jubergDaniel Juberg | Mr. Juberg is a senior consultant with The Camden Group and focuses on clinical integration and ACOs (financial planning and funds flow modeling), Medicare Shared Savings Program applications, and strategic planning. He is also experienced in service line assessment and planning, bundled payments, CMS Innovation Center grants, medical staff needs assessments and development plans, as well as bed needs projections.

 

keberWren Keber Mr. Keber is a manager with The Camden Group and specializes in the development, implementation, and operations of clinically integrated networks (“CINs”) and accountable care organizations. He has assisted hospitals and physician organizations nationwide in achieving clinical integration and success in value-based programs. He has particular expertise in the Medicare Shared Savings Program offered by the Centers for Medicare and Medicaid Service and has advised CINs in their preparation for and participation in the program.

Topics: Accountable Care, MSSP, Webinar, Next Generation ACO Model, MSSP ACO, NGACO

Complimentary Webinars: Next Generation ACOs and MSSP ACOs

Posted by Matthew Smith on Apr 9, 2015 3:37:00 PM

webinar_seriesThe implementation of the new Next Generation Accountable Care Organization (“NGACO”) model for Medicare has made it increasingly clear that ACOs will be a significant part of the government’s commitment to tie 30 percent of traditional Medicare payments to quality or value through alternative payment models by the end of 2016, and 50 percent of payments to these models by the end of 2018.

Whether your organization is just beginning to think about taking steps toward accountable care and considering the Medicare Shared Savings Program (“MSSP”); or if your organization has advanced to the point of considering the NGACO model, The Camden Group’s complimentary webinar series will provide you with background information on the programs to help you make an educated decision as to whether to participate, when to participate and which program is right for your organization.

Join us on Friday, April 17 at 12:00 p.m. ET for the first webinar in the series focusing on the NGACO program. We will discuss the specifics of this new model and the skills needed for a successful launch. Topics will include:

  • An overview of the NGACO model and the key differences between other CMS programs
  • Types of prior experience will be important for success in the NGACO
  • The included alternative payment mechanisms, and unique opportunities for network alignment
  • Next steps and logistics to consider before applying

To register for the NGACO webinar, please click the button below:

NGACO Webinar, Webinar, The Camden Group, Next Generation ACO, Accountable Care Organization

Our MSSP program will be held on Thursday, April 23 at 12:00 p.m. ET. Based on our previous application cycle and operational experience, we will discuss the specifics of the MSSP model and important items for consideration in determining if the time is right for your organization to apply. Topics will include:

  • An overview of the MSSP model and the key differences from other CMS programs
  • The changing value-based landscape and where the MSSP model fits
  • Considerations for leaders evaluating the MSSP program opportunity
  • Key elements and logistics to contemplate before applying*

*The Notice of Intent to apply is non-binding and does not commit an organization to applying. 

To register for the MSSP webinar, please click the button below:

MSSP Webinar, Webinar, The Camden Group, Accountable Care Organization

 

 

 

Our expert facilitators for the webinars include:

bosko_backgroundTawnya Bosko | Ms. Bosko is a senior manager with The Camden Group and specializes in designing and implementing clinical integration, high growth medical service operations (“MSO”) and finance, physician hospital organization (“PHO”) and MSO development, managed care strategy, and physician alignment.

 

 

glaserMishka Glaser | Ms. Glaser is a manager with The Camden Group, specializing in clinical integration, accountable care, and many other innovation strategies. She brings over 15 years of experience in various sectors of healthcare including physician practices, insurance, and pharmaceuticals. Ms. Glaser’s in-depth knowledge of value-based care operations provides a context for assisting clients in navigating population health.

 

jubergDaniel Juberg | Mr. Juberg is a senior consultant with The Camden Group and focuses on clinical integration and ACOs (financial planning and funds flow modeling), Medicare Shared Savings Program applications, and strategic planning. He is also experienced in service line assessment and planning, bundled payments, CMS Innovation Center grants, medical staff needs assessments and development plans, as well as bed needs projections.

 

keberWren Keber Mr. Keber is a manager with The Camden Group and specializes in the development, implementation, and operations of clinically integrated networks (“CINs”) and accountable care organizations. He has assisted hospitals and physician organizations nationwide in achieving clinical integration and success in value-based programs. He has particular expertise in the Medicare Shared Savings Program offered by the Centers for Medicare and Medicaid Service and has advised CINs in their preparation for and participation in the program.

Topics: Accountable Care, MSSP, Webinar, Next Generation ACO Model, MSSP ACO, NGACO

Understanding the Risks and Benefits of Medicare ACO Models

Posted by Matthew Smith on Mar 30, 2015 8:30:00 AM

By Tawnya Bosko, MHA, MSHL, MS, Senior Manager, The Camden Group

aco_logo-goldThe recent announcement by the Centers for Medicare and Medicaid Services (“CMS”) of the implementation of the Next Generation (“NG”) ACO model further solidifies the government’s intention to expediently transition to more value-based reimbursement methodologies. The release of the NG ACO model coupled with the clear direction from the Department of Health and Human Services (“HHS”) that it has established the goal and framework to increase payments tied to quality or value through alternative payment models to 30 percent of traditional Medicare payments by the end of 2016, and 50 percent of payments to models such as ACOs or bundled payments by the end of 2018 sends a strong message to providers that value-based payments and increasing risk-based structures are rapidly evolving. It is increasingly important that healthcare providers not only assess their readiness for the new models, but understand the different characteristics of each and determine the best fit for their organization. Whether or not an organization chooses to participate in the currently available models, the key to success is conducting a well-informed assessment of whether to participate, when to participate, and which model is best suited for the organization. Likewise, organizations that are already participating should assess their Medicare strategy on an ongoing basis.

Should You Participate?

As mentioned and as shown in Figure 1, CMS has issued fairly aggressive goals for transitioning to value-based payment methodologies, which have been further supported by the announcement of the NG ACO model. 

ACO_Figure_1Simultaneously, the overall impact of the Affordable Care Act (“ACA”) has incentivized more efficient care delivery, changed payment methodologies and generally put pressure on hospital operating margins. Hospitals and health systems that historically and largely still today rely on fee-for-service reimbursement face an ongoing quandary of protecting volume to maintain revenues versus transitioning to value-based models where the focus is the right care, at the right time and right place with increased overall value. While hospitals and other healthcare providers are impacted differently, the broad impact is a shift from inpatient to outpatient services (shown in Figure 2) and significant consolidation of the market (shown in Figure 3).

ACO_Fig2Clearly, the healthcare delivery system is changing and aligning to provide more coordinated care; and regardless of the market in which a healthcare provider operates, pressure for change is palpable.

When determining whether or not to participate in one of the Medicare ACO models; or for those that are already participating and assessing their future direction, organizations need to determine how rapidly their market is changing, the implications of the model characteristics, the size of the fee-for-service Medicare market vs Medicare Advantage, their experience with managing risk, the degree to which they are already taking steps to redesign their care ACO_figure3models, the strength of their provider network across the continuum, the size of their patient base, and the difference in financial incentives across models as well as the degree of risk aversion or acceptance for the organization. There are benefits and pitfalls to each of the Medicare ACO models, and the proposed changes to the Medicare Shared Savings Program (“MSSP”) together with the NG ACO structure show that CMS is taking provider experience and comments into consideration as revisions to existing and frameworks of new models are being developed.

When Should You Participate?

There have been mixed results in the MSSP. For example, according to CMS in Performance Year 1:

  • 58 MSSP ACOs held spending $705 million below their targets and earned performance payments of more than $315 million as their share of program savings.
  • One ACO in Track 2 overspent its target by $10 million and owed shared losses of $4 million.
  • 60 ACOs reduced health costs compared to their benchmark, but did not qualify for shared savings, as they did not meet the minimum savings threshold.

And, in the Pioneer ACO Model Performance Year 2:

  • Pioneer ACOs generated estimated total model savings of over $96 million and at the same time qualified for shared savings payments of $68 million.
  • According to the Brookings Institution, 13 Pioneer ACOs reduced costs enough to qualify for shared savings, with an average of $5.85 million returned to the ACOs, ranging from $1million to $14million. One ACO owed shared losses of $2.55 million. The remaining 18 ACOs were within the minimum savings or loss rate and did not earn shared savings or owe money to Medicare due to losses.

However, CMS is making changes to the programs to make them more attractive and to encourage a greater degree of risk taking. Specifically, the proposed rule for MSSP seeks to address the flawed methodology that is used for setting, updating, and resetting an ACO’s benchmark that currently is based on historical performance and introduces a third track with increased risk sharing, among other changes. And, the NG ACO offers increased risk and reward along with a revised benchmarking methodology. Thus, at a time when market dynamics are changing rapidly, and CMS continues to fine tune the structure of the ACO programs, timing of the participation decision is extremely important. Healthcare provider groups and organizations should explore the Medicare ACO models and the implications of each structure to their individual organization and the ramifications of the changes in programs, regardless of whether they are making the decision to participate or deciding whether to change models. Staying ahead of the changes and timing the decision so as to best support the organization’s goals and objectives is recommended.

Which Model is Best for You?

Organizations considering the choice of Medicare ACO models should assess the individual characteristics and capabilities of their organization, the market in which they operate, and the structure, risks and opportunities under the available Medicare ACO models. One of the main considerations for most organizations is the degree to which they are at risk and the extent of sharing in savings. Table 1 depicts a summary of the models available under MSSP and NG ACO.

ACO_table1While increasing focus is being placed on migration to risk as evidenced by the proposed Track 3 under MSSP and the introduction of NG ACO, many provider organizations continue to participate in the Track 1 of MSSP (no downside risk). If revisions to the MSSP program are implemented (as currently proposed), the model may become even more attractive to organizations that have previously opted not to participate but aren’t prepared to take on the level of risk required in NG ACO. On the other hand, the NG ACO model provides an alternative to those organizations that are more advanced in their population health model and ability to manage risk, whether that be organizations currently participating in the Pioneer or MSSP ACO programs, or organizations that have previously not participated. If the Track 3 option is indeed added to MSSP, there will be a range of risk sharing from 40 percent to 100 percent across the models, with a variety of structural characteristics that should also be considered.

With the rising demand from government and commercial payers, employers, and the general public to improve the value of healthcare delivery, provider organizations must continually review their readiness to transition to these new models as well as the appropriate structure to support their ongoing success. Having a detailed plan and projecting overall impact to the organization is critical as is timing of decision-making and implementation. The decision is no longer simply whether or not to participate in Medicare ACOs, but rather, as the system evolves, when should providers engage in or change models and which model will lead to the best outcomes. Making the right decision for the organization is imperative.

Next Generation ACO, ACO, Accountable Care Organization, The Camden Group


bosko_headshotMs. Bosko is senior manager with The Camden Group and specializes in designing and implementing clinical integration, high growth medical service operations (“MSO”) and finance, physician hospital organization (“PHO”) and MSO development, managed care strategy, and physician alignment. She may be reached at tbosko@thecamdengroup.com or 310-320-3990.

 

 

 

 

Topics: ACO, MSSP, Accountable Care Organization, Tawnya Bosko, Next Generation ACO Model, MSSP ACO

New Download: The Next Generation ACO Model

Posted by Matthew Smith on Mar 16, 2015 11:53:00 AM

download_1MobileThe Centers for Medicare and Medicaid Services (“CMS”) recently announced a new Accountable Care Organization (“ACO”) model through its Center for Medicare and Medicaid Innovation ("CMMI"). The new model, called "Next Generation ACO," builds upon the experience gained with the Medicare Shared Savings Program ("MSSP") and Pioneer ACO Models. As with the two existing programs, the Next Generation ACO is a model for traditional fee-for-service ("FFS") Medicare, otherwise known as "Original Medicare."

This new PDF download from The Camden Group presents a concise overview of the new program, including:

  • Next Generation ACO Model Highlights
  • Risk Arrangements
  • Payment Mechanisms
  • Beneficiary Engagement
  • Next Steps

For more information about the CMMI's Next Generation ACO model, please read our previous blog post, CMMI Announces Next Generation ACO Model.

To access and download this PDF, simply click the button below.

Next Generation ACO, ACO, Accountable Care Organization, The Camden Group

Topics: ACO, Medicare, CMS, Pioneer ACO, Next Generation ACO Model, CMMI, Original Medicare

CMMI Announces Next Generation ACO Model

Posted by Matthew Smith on Mar 13, 2015 12:23:09 PM

By Wren Keber, Manager, The Camden Group

ACONews_smallOn Tuesday, March 10, 2015, the Centers for Medicare and Medicaid Services (“CMS”) announced a new Accountable Care Organization (“ACO”) model through its Center for Medicare and Medicaid Innovation ("CMMI"). The new model, called "Next Generation ACO," builds upon the experience gained with the Medicare Shared Savings Program ("MSSP") and Pioneer ACO Models. As with the two existing programs, the Next Generation ACO is a model for traditional fee-for-service ("FFS") Medicare, otherwise known as "Original Medicare."

Program Highlights

The new model has some key differences from MSSP and Pioneer ACOs, which make the program attractive for organizations wishing to take on greater risk and be successful under such risk-bearing arrangements. Specifically, Next Generation ACOs will:

  • Be subject to a new and improved benchmarking methodology, which rewards both attainment and improvement in cost containment. The benchmark ultimately transitions away from comparisons to an ACO's historical expenditures.
  • Have the ability to choose from various payment methods - normal FFS payment, FFS plus a monthly infrastructure payment, population-based payments, or capitation. With all payment arrangements, Next Generation ACOs will have increased risk/rewards compared to MSSP and Pioneer ACOs. A Next Generation ACO will have the ability to transition from normal FFS to more complex methods over time.*
  • Be able to deploy benefit enhancements for beneficiaries, including greater access to home/tele-health, and skilled nursing facilities ("SNFs"), opportunities for beneficiaries to receive a reward payment for receiving care from the ACO, and greater collaboration between CMS and ACOs to improve communication with beneficiaries.
  • Have greater diversity in the types of affiliation arrangements to collaborate with providers who do not wish to fully participate in the ACO as a provider/supplier. The ACO can choose to partner with "Preferred Providers" and other "Affiliates," such as SNFs, to coordinate care and accomplish other ACO functions.

Additionally, beneficiaries will have the ability to proactively confirm or deny their attribution to a Next Generation ACO. According to CMS, "confirmations of care relationships through voluntary alignment [by beneficiaries] supersede claims-based attributions." This addresses the concern of high turnover in beneficiary alignment found in the Pioneer and MSSP models.

Is It For You?

CMS has indicated that the Next Generation ACO model is appropriate for organizations that have experience in coordinating care for populations of patients. This could include current MSSP or Pioneer ACOs, who have seen success in the program participation thus far. If a current Pioneer or MSSP ACO applies for participation in the Next Generation ACO, CMS will seek proof of positive performance and conduct under their current model. The Next Generation ACO may be appropriate for you if you are already experiencing success in the Pioneer or MSSP models, and you are seeking enhanced alignment opportunities with participants and beneficiaries, as well as increased risk and reward corridors.

Even if not already a Pioneer or MSSP ACO, health systems, integrated networks, and other providers may consider the Next Generation ACO model as an option to partner with CMS on an innovative value-based program. Experience in population health management and deployment of clinically integrated or patient-centered programs may lend well to success in the Next Generation ACO model, when coupled with experience with new payment models and management of the total cost of care for a population.

Next Steps

There will be two rounds of Next Generation ACOs, one round with a 2016 start date, and a second with a 2017 start date. CMMI will accept Letters of Intent ("LOIs") for 2016 starters through May 1, 2015. The documents for those applicants will be due by June 1, 2015.

To learn more about this model, or for help in determining if your organization is appropriate to apply for the Next Generation ACO model, please contact Wren Keber at The Camden Group at wkleber@thecamdengroup.com . The Camden Group provides LOI and application support for organizations wishing to apply for the Next Generation ACO model.

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*Per CMS, "to participate in the Next Generation ACO model, ACOs must demonstrate compliance with all relevant state laws and regulations with respect to risk-bearing entities."

Next Generation ACO, ACO, Accountable Care Organization, The Camden Group

Topics: ACO, MSSP, CMS, Accountable Care Organizations, Next Generation ACO Model, CMMI

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