Doctors, hospitals and other healthcare providers have formed 123 new Medicare ACOs, providing approximately 1.5 million more Medicare beneficiaries with access to high-quality coordinated care across the United States.
According to a CMS announcement, the new ACOs include a diverse cross-section of healthcare providers across the country, including providers delivering care in underserved areas. More than half of ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately one in five ACOs include community health centers, rural health clinics, and critical access hospitals that serve low-income and rural communities, CMS said.
In order to participate in the Medicare Shared Savings Program (MSSP), the ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely. The CMS evaluates ACO quality performance using 33 quality measures on patient and caregiver experience of care, care coordination and patient safety, appropriate use of preventive health services, and improved care for at-risk populations.
Doctors, hospitals and healthcare providers establish ACOs in order to work together to provide higher-quality coordinated care to their patients, while helping to slow healthcare cost growth. Since passage of the Affordable Care Act, more than 360 ACOs have been established, serving over 5.3 million Americans with Medicare. Beneficiaries seeing healthcare providers in ACOs always have the freedom to choose doctors inside or outside of the ACO. ACOs share with Medicare any savings generated from lowering the growth in healthcare costs when they meet standards for high quality care.
Affordable Care Act provisions have a substantial effect on reducing the growth rate of Medicare spending. Growth in Medicare spending per beneficiary hit historic lows during the 2010-2012 period, and this trend has continued into 2013. Projections by both the Office of the Actuary at CMS and the Congressional Budget Office estimate that Medicare spending per beneficiary will grow at approximately the rate of growth of the economy for the next decade, breaking a decades-old pattern of spending growth outstripping economic growth.
The next application period for organizations interested in participating in the shared savings program beginning January 2015 will be in summer 2014.
Source: Centers for Medicare and Medicaid Services, December 23, 2013
Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care provides first-year advice from Monarch HealthCare’s Medicare ACO, one of 32 original CMS Pioneer ACOs engaged to test alternative payment and program design models for accountable care organizations.