The Centers for Medicare & Medicaid Services has launched a new initiative for its Accountable Care Organization (ACO) agenda. Called the Next Generation Accountable Care Organization Model , the new payment and care delivery approach sets predictable financial targets, gives providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.
Part of the Affordable Care Act, ACOs encourage various healthcare providers and entities to work in concert to ensure optimal outcomes while containing costs. Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program, the Next Generation ACO Model aims to leverage lessons learned and expand the model.
“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,” said HHS Secretary Sylvia M. Burwell. “This model is part of our larger effort to set clear, measurable goals and a timeline to move the Medicare program — and the healthcare system at large — toward paying providers based on the quality, rather than the quantity of care they give patients.”
The ACOs in the Next Generation ACO Model will take on greater performance risk than ACOs in current models, while also potentially sharing in a greater portion of savings. To support increased risk sharing, ACOs will have a stable, predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure that provides high quality care to patients.
Other aspects of the new initiative:
- The new ACO model encourages greater coordination and closer care relationships between ACO providers and beneficiaries.
- ACOs will have a number of tools available to enhance the management of care for their beneficiaries. These tools include rewards to beneficiaries for receiving their care from physicians and professionals participating in their ACOs, coverage of skilled nursing care without prior hospitalization, and modifications to expand the coverage of telehealth and post-discharge home services to support coordinated care at home.
- The Next Generation ACO Model also supports patient-centered care by providing the opportunity for beneficiaries to confirm a care relationship with ACO providers and to communicate directly with their providers about their care preferences.
CMS will accept ACOs into the Next Generation ACO Model through two rounds of applications in 2015 and 2016, with participation expected to last up to five years. Organizations interested in applying in 2015 must submit a Letter of Intent by May 1, 2015, and an application by June 1, 2015. Second round Letters of Intent and applications will be available in spring 2016.
