The Centers for Medicare & Medicaid Services (CMS) recently announced 21 participants in its Next Generation accountable care organization (ACO) model.
Under the Next Generation model, provider groups can assume a higher level of financial risk than in previous CMS initiatives such as the Pioneer ACO model and the Shared Savings program. The model includes a prospectively set benchmark, allows beneficiaries to choose to be aligned to the ACO, tests incentives for beneficiaries to seek care with providers and increases the availability of telehealth and care coordination services.
ACOs in the Next Generation model will receive their budgets before the year and can plan accordingly to reach their targets.
“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,” CMS said in describing the Next Generation initiative.
CMS also announced on Jan. 11 that 100 new ACOs joined the Medicare Shared Savings program this year. In all, 434 ACOs serving more than 7.7 million beneficiaries are participating in the Medicare Shared Savings program.
In addition, 39 Medicare Shared Savings program ACOs will participate in the ACO Investment Model, which provides pre-paid shared savings to encourage ACOs to form in rural and underserved areas.
CMS defines ACOs as groups of doctors, hospitals and other healthcare providers and suppliers that coordinate care and attempt to deliver high quality care and lower costs. Providers volunteer to participate in ACOs, and beneficiaries can continue to visit any provider and see how change in their Medicare benefits.
In 2014, the 333 Medicare Shared Savings program ACOs and the 20 Pioneers ACOs had a combined total net program savings of $411 million, according to CMS.
CMS projects there will be a total of 477 ACOs in 2016 that serve nearly 8.9 million beneficiaries. Of the ACOs, 64 are in a risk-bearing track.
The 21 ACOs included in the Next Generation model are:
- Accountable Care Coalition of Southeast Texas Inc.
- Baroma Accountable Care, LLC
- Beacon Health, LLC
- Bellin Health DBA Physician Partners, Ltd. (PPL)
- Cornerstone Health Enablement Strategic Solutions, LLC (CHESS)
- Deaconess Care Integration
- Henry Ford Physician Accountable Care Organization
- Iowa Health Accountable Care
- MemorialCare Regional ACO, LLC
- Optum Accountable Care Organization
- OSF Healthcare System
- Park Nicollet Health Services
- Pioneer Valley Accountable Care, LLC
- Prospect ACO CA, LLC
- Regal Medical Group, Inc.
- River Health ACO, LLC
- Steward Integrated Care Network, Inc.
- ThedaCare ACO LLC
- Triad HealthCare Network, LLC
- Trinity Health ACO Inc.
- WakeMed Key Community Care, LLC