The non-partisan Congressional Office weighed in today on the impact of the Better Care Reconciliation of of 2017 as amended and rebranded as the ‘Obamacare Repeal Reconciliation Act’.
Their summary notes the coverage impact as follows:
- The number of people who are uninsured would increase by 17 million in 2018, compared with the number under current law. That number would increase to 27 million in 2020, after the elimination of the ACA’s expansion of eligibility for Medicaid and the elimination of subsidies for insurance purchased through the marketplaces established by the ACA, and then to 32 million in 2026.
- Average premiums in the non-group market (for individual policies purchased through the marketplaces or directly from insurers) would increase by roughly 25 percent—relative to projections under current law—in 2018. The increase would reach about 50 percent in 2020, and premiums would about double by 2026.
On the fiscal impact the graphic lays it out below: For a complete CBO report, click here.
Unlike many in the conversation on social media including the likes of Twitter, Facebook, LinkedIn and blogs such as ACO Watch, I have been active in the health reform exchange of ideas since registering my twitter handle @2healthguru in August of 2008. My participation has been of the ‘sweat equity’ variety vs. those who are compensated for their content, curation or advocacy.
Many of us in the healthcare space (both clinical and administrative) are addicted to the industry and find it difficult if not impossible to exit whether physically or emotionally. Some commit out of a sense of mission, giving back or being of service, while others for the economic upside this vast ecosystem (which I have labeled the healthcare borg resisting any attempt to materially restrain its appetite) affords to exploit low hanging fruit from a fragmented, inefficient and unwieldy financing and delivery system. Many have personally enriched themselves via the frequent churn of asset ownership (hospitals, nursing homes, imaging centers, ambulatory surgery centers, etc.) or via niche solutions with little to no sustainable value followed by quick exits and generous investor returns.
This timing of my entry into social media was co-incident with the deliberative process that ultimately rendered unto the American public what was merged as the Affordable Care Act (ACA),
In the early days of twitter those of us active in the community spoke of the ‘addictive’ nature of twitter engagement, some even referred to this virtual community as ‘the matrix’. Bonds were formed, some of which remain intact to this day.
The ‘Fictional’ Obamacare ‘Disaster’
This morning Donald J, Trump aka the POTUS weighed in on the failed efforts of Senate GOP leadership to advance the Better Care Reconciliation Act of 2017 as amended by Senator Ted Cruz to the Senate floor. He said:
That this man continues to minimally misrepresent and worse intentionally lie to the American public is beyond the capacity for many to comprehend. From the American Academy of Actuaries to the Non-partisan Congressional Budget Office and multiple authorities in the underwriting to delivery space including risk bearing provider organizations and integrated delivery systems the narrative is quite to the contrary.
And where there is evidence of market instability or ‘failure‘ there is explanation including serial GOP initiatives to undermine the Affordable Care Act specifically with respect to ‘qualified health plans‘ (QHPs) listed on State run or Federally Facilitated Marketplaces (FFM) aka ‘Exchanges.’
The ‘death spiral‘ or ‘disaster‘ narrative is principally vested in the following argument:
- Major health plans and regional players who initially developed individual market product(s), i.e., benefit plans, and associated provider networks including premiums) for these exchanges are withdrawing participation from select markets.
- Premiums for some QHPs have increased by 100% or more on select exchanges; and
- In some states and select counties there are no participating health plans with QHPs offered
On the face of this narrative, yes it makes sense. This market instability is unacceptable. No one can celebrate a law who’s principal intent is to expand coverage can applaud the absence of health plan participation at the state or county level.
But let’s peel back the curtain and look at the reasons for this ‘instability‘ claim. From day one of the Obama Administration, the GOP agenda was to make him a ‘one term President‘.
On the ACA given it’s passage was a straight line party vote with no support from GOP even though the health reform consideration process was an open and lengthy affair, Senator McConnell et al’s agenda was to remain the ‘party of no‘ and criticize the very model of health reform they had not long ago proffered as a public/private solution, See: ‘GOP ACA Myths‘ where I’ve posted links to credible voices and JD Kleinke’s classic: ‘Why There Is No Obamacare Replacement — In One Picture‘.
The bottomline is any ‘fails’ or under performance of the ACA whether enrollment projections, premium sticker shock, exchange exits or regulatory burdens have been engineered by a relentless series of sabotage efforts from defunding risk corridors, to current (see: This Blame Game Driving Up Health Insurance Costs) threats to not fund the subsidies that make QHP listed plans ‘affordable‘. And let’s not forget the big SCOTUS decision on Medicaid expansion which gave Red State Governors the ‘option’ whether to expand coverage for their citizens.
So the ‘who knew healthcare was so complex’ remark offered by POTUS earlier this year was pure BS. I buy his ignorance of health policy and the complexity inherent in a cottage industry with a $3+ trillion spend, but what about those GOP ‘health wonks’ engaged in this process – from the ‘Senate Quackers’ (my term), i.e., Tom Coburn and John Barrasso – both politicians playing the doc card during ACA markup in 2009, or even worse one half of the GOP ‘young guns’ now Speaker Ryan who’s a budget [and by declaration health] wonk. What’s their excuse for this ‘surprisingly epic fail’?
This is a HUGE squander of the public trust! And contrary to POTUS assertions, the GOP now has complete ownership of the chaos they’ve stoked from the beginning to this gross mis-management of the legislative process. It’s laughable that GOP are trying to pin this one on the Democratic party.
My god, wake up GOP. You ‘own’ healthcare. Fix the ACA.
Transforming a $3.2+ trillion dollar economy where approximately 1 in 5 dollars of GDP finds its way into the healthcare financing and delivery ecosystem is no small challenge. Decades of variably branded health policy initiatives from HMOs and PPOs to their arguably derivative reincarnated ‘brethren’ ACOs all presented with the promise of taming what remains a rather rapacious appetite for ‘more‘ in a complex do more to earn more web of financial incentives.
The most recent addition to this effort was delivered via the Affordable Care Act courtesy of President Obama in March of 2010. Accountable Care Organizations (ACO’s) are defined as follows:
ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.
The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. – Centers for Medicare and Medicaid
Meet Dr. Andre Berger
Andre Berger, MD is a busy man committed to move the needle towards the seemingly conflicting goals of the ‘tripe aim’ – better experience of care, with improved outcomes at lower per capita costs.
This multi-board certified physician has a lot on his plate – a busy cosmetic surgery and anti-aging medical practice as well as the chief executive officer of a primary care physician led and governed next generation accountable care organization (ACO) with a successful five year operating history.
I first learned of Dr. Berger as a result of my interest following and reporting on Accountable Care Organizations (ACOs) for ACO Watch. Dr. Berger was listed as the CEO of National ACO admitted to the first class of participating ACOs in the Medicare Shared Savings Program (MSSP) as an advanced payment model. Then I noticed the office for National ACO was headquartered in Beverly Hills, California on the very street I called ‘home’ while serving as Director of Managed Care for American Medical International (now operating as Tenet Healthcare) California Region – I thought to myself what a coincidence! I need to learn more about this enterprising physician and wondered why a surgeon specializing in a direct pay (non 3rd party reimbursed) specialty for often ‘non-covered’ services from a typical group or individual health benefit point of view, be leading such an effort?
This co-mingling of seemingly divergent interests convinced me there is a deeper story to uncover possibly with an important message for physicians, hospitals, and patients given the current instability of our volume driven healthcare delivery and financing model.
Fast forward some four years + later, and I’ve been invited to advise National ACO on their social media presence and to develop a portfolio of digital assets for a growing thought leadership library.
On recent trip from South Lake Tahoe to cover BIO 2017 the global annual go-to gathering of the best and brightest minds in the biotech sector in San Diego, I was invited in to ‘shadow’ Dr. Berger and get a feel for a typical day in his life at the helm of National ACO.
Tuesday 8:30 AM
While Dr. Berger is CEO of National ACO (NACO) a growing enterprise with lean staffing he maintains his clinical practice so balancing workflow is a challenge addressed by having dedicated NACO days, and in office or surgery patient days. Today was an NACO day.
Dr. Berger arrives at the office equipped with briefcase including his accessorized iPhone, MacAir, iPad. AppleWatch, associated peripherals and a series of file folders. What follows is a series back-to-back phone calls, tech-enabled virtual staff meetings and seemingly non-stop text messaging.
The first call is with the Medical Director of NACO’s PET (provider engagement team) and the subject is physician performance (both quality and financial) reviews.
Next up is executive staff meeting with a long list of action items finalizing a progress report due to CMS.
Key themes include overall and regional performance of on annual wellness visits (AWV) and chronic care management (CCM) programs.
Given growth in NACO there’s considerable discussion on staffing needs, particularly acute is recruiting a Director of Care Management given a tight market and low supply of candidates, NACO may need to retain search firm. Finding qualified case managers and care management staffs sound equally challenging.
The ‘mobile physician’ waiver (allowing physician access to patient’s homes to provide transitions of care consults) is delegated to the chief medical officer, NACO plans to deploy in Q3. Will help with CM staffing and population management.
Provider Network Managers to inventory ‘at risk’ patients to put on care managers’ priority screening. Is vendor a reliable source? May need to vet further for accuracy and then prioritize.
Other agenda items included: contracting with nursing homes, hospice providers, reviewing stop loss policy, discussion of ESRD patient mix, and possibility of contracting with key nephrologist or nephrology group(s).
All with intent to ID ‘preferred providers’ and ultimately tag for population based payments.
9:30 AM GOTO Meeting Conference Call (to review performance results)
Reviewing IT vendor dashboard detailing physician performance by ACO, region, etc. Considerable discussion on the need to manually design custom reports and the duty of that burden falling on the physician or whomever is pulling the data have to input the requested parameters.
Further discussion topics include: evidencing completion events for quality metrics reporting, the status of hospital real time ‘ping system‘ alerting ACO physicians of admits, discharges or transfers. It was affirmed that efficacy of the notification program requires two pings: one to admitting physician, the second to NACO medical director.
Considerable discussion on vendor performance and opportunities for workflow improvement.
HR issues (mostly need for additional staff).
Dilution agreement (issues associated with NACO capital raise via PPM to participating physicians, medical groups or IPAs.
10:10 Management Meeting – Agenda
Routine conversation on travel policy and company preference to avoid ‘non refundable’ airline ticket purchases. Recommended leveraging tools available via concierge support services as often as practical.
Balance of meeting agenda deferred to NACO operations manager. On tap is IRR review of ’Project Plan Requirements’.
Define compliance reporting to NGACO Governing Body members. What does this include? In the minutes. All needs to line up with contracting obligations.
Definition of ‘beneficiary representative’ who is this? Definition of ‘Certified Participants’? Quest was submitted by NACO as ‘preferred provider’.
Same (COI) issue for ‘consumer advocate’.
Key issue is defining ‘joint venture’ (JV)? For purposes of disclosure requirements. Are lab vendor relationships a JV? What about PBMs?
Training and Education program need be developed. Need to source CMS requirements NGACOs.
Need project format with due dates and compliance checks.
Letter re: advantages of joining NACO. Details calculations and benefits of affiliation.
Need fine tune the ‘marketing materials’ for physician recruitment and any special considerations for appeal via IPAs.
Physician outreach need stay away from ‘guarantees’, but stipulate shared savings participation on an ongoing performance basis.
Next Generation ACO Deadlines and Calendar: Webinar schedule, voluntary alignment dates, provider risk stratification meeting, the need for executive breakout session to review tier assignment, engagement level and appropriate notice and cure periods. Deadline is 9/29 for removal from NACO panels. Report period 2017 or rolling 12 months.
Recent submission to CMS certified. Break out by physicians, TINs and preferred providers.
Population Based Payment: what’s plan, deadline and status?
PBP Agreements are just now being sent out to target physicians.
Follow-up planned one week post mailing.
Senior staff query: how are we engaging our medical directors to facilitate recruitment and participation PBP program? May need to develop video on PBP program directed to target physicians with outreach via NACO medical directors.
Chronic Care Management program update included number of care plans completed, outbound call volumes, number of patients in program, sorted by minutes to meet marks.
Care Manager recruitment status report.
Revenue pro-forma review, including ‘consent’ status and whether ‘on plan’ or not.
Group recruitment update: Signs two agreements to perfect NACO/Group relationships: TIN affiliation agreement, and group participation agreements.
Channel partner initiative. Vetting potential IPAs for outreach purposes.
When recruiting multiple docs, NACO assists with formation of ‘POD’. How defined? Filing required. Maybe role for regional PODs or eve ’super PODS’.
When they get participation letter, who do they call? No specific name listed. Now only directed to general phone number.
SNF Rollout. Primary scope is 3 day SNF waiver portion. Tracking referrals and performance needs improvement.
Remainder of agenda included: Referral tracking and management vendor options, telehealth update, AWV proposal plan given 27.8% completed 2017 v. 21% in 2016 performance and target at 70-80%.
ACOs that incentivize AWVs show shared savings. Need see ROI on internal vs. outsourced AWVs.
Status of group recruitments in California, Colorado and other regions.
Worked on letter on ’physician recruitment’ upsides of participation.
Review responses to RFP for IT vendor replacement.
Review of marketing and communication efforts including social media activities.
Conference call with IT vendor RFP consultant, with status vendor submission ratings.
Free flowing debrief with Dr. Berger on day’s wide ranging and non-stop series of activities. Included question of whether or not to re-do a previous broadcast of This Week in Accountable Care which experienced some audio quality issues due to the moderator originating the broadcast from BIO International Conventions media center.
Calling it a day, Dr. Berger drops me off at my car.
It’s very clear to me that managing an institutionally ‘untethered’ and physician led ACO – while more agile, if you will – is none-the-less a complex and challenging affair. There are many moving parts and with multiple parties coming into and out of key management decisions – both virtually and ‘IRL” – with all the attendant people and systems’ challenges, keeping focused and moving the enterprise forward takes constant vigilance.
When you add the complexity of the volume-to-value transformational imperative into the successful operation and scaled growth into the enterprise agenda, you begin to get a picture of what Dr. Berger, his physician colleagues and administrative staff face on a daily basis.
When you add the advantages (and associated duty to leverage them in support of the elusive triple aim) afforded by CMS specific to Next Generation Models such as National ACO, that complexity takes on an additional duty of care to manifest the ambitious but worthwhile mission of transforming U.S. Healthcare from a volume driven system to one that materially embraces a value based and outcomes oriented future.
My hat is off to this ambitious physician enterprise!
When the Affordable Care Act passed in March of 2010 and the law’s many moving parts analyzed by the ecosystem stakeholders including operators, health wonks and patient advocates many weighed in that ACOs were doomed to fail. They were just too ‘tepid’ to make a material contribution to the volume to value transformational journey. Complaints included little control over patients who ‘voted with their feet’ while ACOs bore the liability of their choices whether in upside only track vs. the downside of exposure of track two, flawed retrospective attribution methodologies and data dumps and reporting lags from CMS all handicapped the proactive management of ‘risk’ assumed by participating ACOs in the Medicare Shared Savings Program (MSSP).
Noted futurist Jeff Goldsmith captured the spirit in Pioneer ACOs: Anatomy Of A ‘Victory’ post in Health Affairs:
With over 17 million Medicare beneficiaries voluntarily choosing MA thus far, and enrollment growing at more than 10 percent annually despite three years of CMS payment reductions in real dollars, it is increasingly clear the future of managed Medicare lies in the MA program, not with directly contracted shared savings models.
Co-incident with the ramp up of the Medicare ACO cohort the private sector jumped on the bandwagon, operating with higher degrees of contractual terms and conditions freedom than promulgated by CMS to participating MSSP’s. Aetna, the Blues, United et al negotiated their version of ‘accountable care’ arrangements with participation IPAs, PHOs, IDNs, health systems, medical groups or physician networks.
Five years later, we have some important data recently reported by Health Affairs that suggests ACOs are far from the neutered enterprises many suggested and while mixed in terms of results reported ACOs have found their place in the managed competition ecosystem and are not likely to disappear any time soon.
The headline at Health Affairs is as follows: Growth Of ACOs And Alternative Payment Models In 2017.
As of the end of the first quarter of 2017, our inventory included 923 active public and private ACOs across the United States, covering more than 32 million lives (Figure 1). The increase of 2.2 million covered lives in the past year means that more than 10 percent of the U.S. population is now covered by an accountable care contract (Note 1).
As the ACO model matures, there is now some turnover, with organizations joining and leaving the model. Since the first quarter of 2016, 138 new ACOs began operation, and 46 ACOs dropped their accountable care contracts, representing a net increase of 92 organizations becoming ACOs, or an 11 percent growth.
From the nominal ACO count basis to the number of lives associated with the aggregate arrangements, this is an impressive tally for such an allegedly ‘anemic‘ model!
As announced in ‘Next Generation ACOs: A Deep Dive Series‘ we’re launching a multimedia (blog, internet radio, social media and community tweetchats) programming schedule that will focus on the accountable care industry with specific deep dives into select participants in the cohort admitted by the Center for Medicare and Medicaid Innovation.
Written versions of those interviews will post on ACO Watch, with audio versions featured on ‘This Week in Accountable Care’ on the BlogTalk Radio and Affiliate Networks.
If you are interested in the Next Generation ACO Model, see: ‘The Next Generation ACO: Accelerating the Transformation from Volume to Value‘ and the CMS ‘Webinar: Next Generation ACO Model – Overview and LOI Information with key webinar dates and application deadlines.
For those interested in learning more about the rather ‘eclectic’ (academic, physician led, hospital system sponsored and venture backed) class of 44 ACOs in the NextGen Cohort, I’ve listed them below:
- National ACO, California
- Park Nicollet Health Services, Minnesota
- Pioneer Valley Accountable Care, Massachusetts
- Prospect ACO CA, California
- Deaconess Care Integration, Indiana
- Accountable Care Coalition of Southeast Texas, Texas
- Bellin Health dba Physician Partners, Wisconsin
- Beacon Health, Maine
- MemorialCare Regional, California
- Optum Accountable Care Organization, Arizona
- Trinity Health ACO, Michigan
- Baroma Accountable Care, Florida
- Cornerstone Health Enablement Strategic Solutions, North Carolina
- Iowa Health Accountable Care, Iowa (Deck)
- Henry Ford Physician Accountable Care Organization, Michigan
- Steward Integrated Care Network, Massachusetts
- Triad healthCare Network, North Carolina
- ThedaCare ACO, Wisconsin
- Michigan Pioneer ACO, Michigan
- Dartmouth-Hitchcock Health, New Hampshire
- Allina Integrated Medical Network, Minnesota
- Atrius health, Massachusetts
- Integra Community Care Network, Rhode Island
- HCP ACO California, California
- Physicians of Southwest Washington, Washington
- UT Southwestern Accountable Care Network, Texas
- Accountable Care Options, Florida
- Premier Health ACO of Ohio, Ohio
- KentuckyOne Health Partners, Kentucky
- Fairview Health Services, Minnesota
- Prospect ACO Northeast, California (WITHDRAWN)
- St. Luke’s Clinic Coordinated Care, Idaho
- ProHealth Solutions, Wisconsin
- Indiana University Health, Indiana
- Bronx Accountable Healthcare Network IPA, New York
- Hill Physicians Medical Group, California
- Sharp HealthCare ACO, California
- Regal Medical Group, dba Heritage California ACO, California
- Carilion Clinic Medicare Shared Savings Company, Virginia
- Arizona Care Network, Arizona
- Accountable Care Coalition of Chesapeake, Texas
- Monarch Health Plan, California
- APA ACO, California
- UNC Senior Alliance, North Carolina
- Partners Community Physicians Organization, Massachusetts
We intend to host monthly moderated ‘tweetchats’ to engage the community of stakeholders via #ACOchat and welcome your input on the preference of the participating ACOs you’d like us to profile.
Please post in the comments section.
*Editor’s Note: This post including This Week in Accountable Care broadcasts, periodic tweetchats via #ACOchat and blog posts in this series) are sponsored by National ACO, a Next Generation ACO. For more information on National ACO, click here.
Since ACOs arrived in 2012 courtesy of the Section 3022: Medicare shared savings program, under Title III, Subtitle A, Part 3 of the Affordable Care Act (ACA) as the ‘new, new thing’ layered into a complex healthcare ecosystem peppered with more or less successful public/private efforts to restrain healthcare inflation, promote greater patient/member access, provide seamless coordinated care at lower per capita costs with better documented quality (the triple aim), ACOs have booked modest, variable but increasingly scalable impact via sponsored hosts from institutional health systems to physician driven enterprises.
A Brief Timeline
In 1973 President Richard Nixon signed into law the ‘HMO Act‘ officially launching ‘managed care‘ principally via closed ‘staff‘ and ‘group‘ model HMOs catering to niche (vs. ‘mainstream’) segments of key industry stakeholders, i.e., members (patients), employers, participating physicians and hospitals.
In the early to mid 80’s we witnessed the accelerated migration from narrow market penetration to mainstream medicine validation of the HMO model via the emergence of network models typically enabled by then emerging ‘Independent Practice Associations’ (IPAs).
Most IPAs emerged as a loose confederation of participating physicians as many physicians engaged out of a sense of curiosity or defensive hedging to not lose patients. First generation IPA’s featured at best tepid economic bonds, thus alignment of member physicians with the entity ‘leadership‘ (i.e., the Management Services Organization) goals were often ‘incidental considerations’ to many participating physicians. There just wasn’t enough ‘skin in the game‘ or economic integration, i.e., losing a withhold against a fee-for-service schedule just didn’t make that much of a difference from a total compensation point of view.
In the mid 80s principally in California Preferred Provider Organizations (PPOs) emerged and launched the era of discounted fee-for-services contracting for hospital, physician and ancillary services. PPOs were an HMO-lite version as members/beneficiaries voted with their feet within the network based on ‘in network’ benefit plan incentives vs. the closed loop (gatekeeper) HMO model.
In the 90s as mainstream initiatives continued to evolve and mature we witnessed the emergence of Physician/Hospital Organizations (PHOs) more often than not a joint venture between a host hospital (or parent health system) and a member physician organization (typically one or more IPAs or multi-specialty medical groups). PHOs were contracting vehicles and typically supported by an affiliate or owned MSO. Few PHOs entered into full risk arrangements with payors.
For prior comment and context on the evolving market, check out ‘Hey, Remember IPAs, PPOs and TPAs?’
Enter the ACO
While an ‘alphabet soup‘ of healthcare cost containment and quality improvement acronyms enshrined themselves into US healthcare delivery and financing lexicon (HMO, IPA, PPO, PHO, MSO, EPO, DPA, OWAs [other weird arrangements]), healthcare consumption of GDP continued it’s relentless upward growth – though somewhat moderated post passage of ACA.
In 2012 27 ACOs officially launched under the terms and provisions of the Medicare Shared Savings Program (MSSP) via a cohort sourced from 18 states serving an estimated 375,000 beneficiaries. Approximately half of the participating ACOs were physician-led, per the Center for Medicare and Medicaid Innovation (CMMI) – the administering agency.
Amidst ‘mixed results‘ considerable provider input to CMMI via open door forums and NPRM comments the ensuing years witnessed many tweaks to the rules associated with both the MSSP and Pioneer programs. In January of 2015 then Secretary of Health and Human Services Sylvia Burwell set goals for migration of payments from volume to valued based arrangements, see: ‘HHS Sets Specific Targets and Timelines for Alternative Payment Models and Value-Based Payment‘:
By the end of 2016, HHS plans to make 30 percent of FFS payments through APMs, such as accountable care organizations (ACOs) and bundled payments, and tie 85 percent of all FFS payments to quality or value. By the end of 2018, HHS intends to pay 50 percent of FFS payments through APMs, and tie 90 percent of FFS payments to quality or value.
This represents the first time in my 30+ years in healthcare delivery and financing innovation space that the Federal government has explicitly benchmarked industry migration away from its prevailing fee for services DNA.
While many pronounced ACOs as ‘DOA’ (dead on arrival) for many reasons, truth be told they’ve found their way into the managed competition ecosystem and are not going away anytime soon. In fact as is the case with most innovation, the ACO formula has been tweaked both in terms of its Government DNA (MSSP, Pioneer models, etc), and it’s private pay or commercial derivatives.
Meet the ‘Next Generation ACO Model’
The de facto amalgam of much of the lessons learned and serial tweaks imposed since the first class of ACOs launched in 2012 can be found in the Next Generation ACO Model, see: ‘The Next Generation ACO: Accelerating the Transformation from Volume to Value‘.
Per CMS, the model is defined as:
The Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients. It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP). The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.
Included in the Next Generation ACO Model are strong patient protections to ensure that patients have access to and receive high-quality care. Like other Medicare ACO initiatives, this Model will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures. This is in accordance with the Department of Health and Human Services’ “Better, Smarter, Healthier” approach to improving our nation’s health care and setting 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 provide to patients. In addition, CMS will publicly report the performance of the Next Generation Pioneer ACOs on quality metrics, including patient experience ratings, on its website.
A thorough application vetting process by CMS will assure participating ACOs admitted to the ‘NextGen’ cohort will present with the track record and capabilities to assume and manage the risk inherent in the model. Rather than bolt a new model on a legacy fee-for-services platform, CMS is fueling the necessary innovation to achieve the triple aim via a network of risk savvy ACOs.
Next Generations ACOs will deploy three (3) powerful ‘benefit enhancement‘ tools as they re-engineer clinical workflows and the prudent utilization of acute and sub-acute healthcare resources. This includes:
- Telehealth Expansion Waiver
- Post-Discharge Home Visit Waiver, and
- Three-Day Skilled Nursing Facility Waiver
First up as we cycle through and profile best in class Next Generation ACOs is National ACO, led by industry pioneers and co-founders Andre Berger, MD, CEO and Alex Foxman, MD, FACP, President and Chief Medical Officer who serve as co-hosts of this series.
The series launches May 23, 2017 from 5PM – 5:30 PM Pacific/8PM – 8:30 PM Eastern. You can listen both live or on demand via This Week in Accountable Care.
We’ll discuss the model, their backgrounds and history in managed care and why they were drawn to form National ACO. We’ll close with comments from Alex Fair, CEO of the equity crowd funding platform Medstartr who will detail the recent listing of National ACO.
*Editor’s Note: This post including This Week in Accountable Care broadcasts, periodic tweetchats via #ACOchat and blog posts in this series) are sponsored by National ACO, a Next Generation ACO. For more information on National ACO, click here.