CMS introduces New ACO Model

According to a blog post by Patrick Conway, MD, Deputy Administrator for Innovation and Quality and Chief Medical Office, Centers for Medicare and Medicaid Services (CMS), CMS is unveiling its next generation Accountable Care Organization model, which it hopes will provide an attractive alternate for providers not yet participating in the ACO program. 

How the new model works

The new model uses a combination of fee-for-service and capitation. It creates four payment systems and two risk tracks for its participants, including one with almost full risk.

According to Conway, the Next Generation ACO Model sets more predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality of care.  Key features of the new model include:

  • ACOs will take on greater financial risk than those in current Medicare ACO initiatives, while also potentially sharing in a greater portion of savings.
  • To support increased risk, ACOs will have a stable, predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure to provide high quality care to patients. These changes are responsive to feedback from external stakeholders.
  • Encourages greater coordination and closer care relationships between ACO providers/suppliers and beneficiaries by enhancing services that beneficiaries can receive from participating ACOs. ACOs will have a number of tools available to enhance the management of care for their beneficiaries. These include additional coverage of telehealth and post-discharge home services, coverage of skilled nursing care without prior hospitalization, and reward payments to beneficiaries for receiving care from ACOs.
  • Provides for greater engagement of beneficiaries, a more predictable, prospective financial model, and more tools to coordinate care for beneficiaries.

CMS has posted more information on the Next Generation ACO Model web site.