New CMS ACO Model Takes on More Risk With Potentially Greater Rewards

Building on the experience gained in the Pioneer ACO Model and the Medicare Shared Savings Program (MSSP), CMS has announced the Next Generation Accountable Care Organization (ACO) Model, a new payment and care delivery model that takes on greater performance risk but could potentially mean greater reward for participants.

ACOs in the Next Generation ACO Model will have more predictable financial targets to meet as well as a number of tools available to enhance care management of their beneficiaries, such as telehealth, post-discharge home services, coverage of skilled nursing care without prior hospitalization, and reward payments to beneficiaries for receiving care from ACOs, Patrick Conway, MD, deputy administrator for innovation and quality and chief medical officer at CMS, wrote in a blog post.

“The Next Generation ACO Model is one of many innovative payment and care delivery models created under the Affordable Care Act, and is an important step towards advancing models of care that reward value over volume in care delivery,” HHS Secretary Sylvia M. Burwell, said in a statement. “This model is part of our larger effort to set clear, measurable goals and a timeline to move the Medicare program—and the health care system at large—toward paying providers based on the quality, rather than the quantity of care they give patients.”

There will be 2 rounds of applications in 2015 and 2016 for acceptance in to the Next Generation ACO Model. Participation is expected to last up to 5 years.

FierceHealthcare reported that the ACO model will have 2 risk tracks—one of which will be “essentially near 100% risk,” Dr Conway said during a phone call—and 4 payment systems. Dr Conway added that he expects the model to attract between 15 and 20 ACOs.

“This ACO model provides for greater engagement of beneficiaries, a more predictable, prospective financial model, and more tools to coordinate care for beneficiaries,” he wrote.