New CMS ACO Investment Model Supports Coordinated Care for Rural, Underserved Areas

Up to $114 million in infrastructure and redesigned care processes is being invested in up to 75 eligible Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP), according to the Centers for Medicare & Medicaid Services (CMS).

The new ACO Investment Model will encourage quality improvement and care coordination through the use of health information technology (HIT) among rural and underserved areas, helping to bolster the value-based, preventive mindset currently at the core of most healthcare models.

The upfront investments will give participating Medicare ACOs more flexibility in setting quality and financial goals, while giving them greater accountability for delivering quality care efficiently, CMS officials say. They will also help increase the number of beneficiaries — regardless of geographic location — that can benefit from lower costs and improved healthcare through Medicare ACOs. CMS will recover these payments through an offset of an ACO’s earned shared savings.

Participation in the ACO Investment Model will be limited to two distinct groups:

  • New Shared Savings Program ACOs joining in 2016 — To encourage uptake of coordinated, accountable care in rural geographies and areas where there has been little ACO activity, CMS will offer pre-payment of shared savings in both upfront and ongoing per beneficiary per month payments.
  • ACOs that joined the Shared Savings Program in 2012, 2013 and 2014 — To encourage continued success in the shared savings program and encourage progression to higher levels of financial risk, ultimately improving care for beneficiaries and generating Medicare savings.

Payments will depend on when the ACOs began participating in the MSSP. Those joining in 2016 will receive one of three payments: an upfront fixed payment, an upfront variable payment, depending on its number of preliminary beneficiaries, or a monthly payment of varying amount depending on the size of the ACO.

Those ACOs already participating in the MSSP will be offered one of two payments: an upfront variable payment or a monthly payment of varying amount.

The application deadline for organizations that started in the MSSP in 2012 or 2013 will be December 1, 2014. Applications will be available in the summer of 2015 for ACOs that started in 2014 or will start in 2016.

Source: CMS , October 15, 2014

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