As Next Generation ACO Deadlines Loom, Organizations Assess Risk Tolerance

Monday, April 11th, 2016
This post was written by Patricia Donovan

Next Generation ACO readiness assessment

There are 17 key questions organizations should ask to help determine Next Generation ACO readiness.

Although letters of intent for the next round of CMS’s Next Generation ACOs are due in just three weeks, accountable care organizations applying to this program are not committed to joining until December 2016, Healthcare Strategy Group reminded participants during Next Generation ACO: An Organizational Readiness Assessment, an April 2016 webinar now available for replay.

Because the three-part NGACO application—letter of intent, or LOI (now due May 20), the Next Generation ACO application (due May 25) and the participating provider list (due June 3)—are all non-binding, Healthcare Strategy Group’s Travis Ansel, senior manager of strategic services, and Walter Hankwitz, senior accountable care advisor, encouraged organizations with any interest in CMS’s latest ACO model to submit these items to CMS while continuing to evaluate whether the Next Generation ACO program is right for them.

In regards to the NGACO provider list, there are two important considerations, Hankwitz added. First, while non-binding, the provider list cannot be revised once submitted.

Second, as the provider list pertains to the Physician Quality Reporting System (PQRS), if a participant’s name, be it a physician or an allied health professional, is not on the provider list submitted by June 3, that provider will not be eligible to be qualified for PQRS through the ACO the following year.

“They do have to submit their PQRS information,” said Hankwitz. “It’s very critical that you develop your network, have your network in place completely, and have every participant documented specifically on that list for June 3.”

In their comprehensive NGACO assessment, the pair walked through the five key elements of the model, including attribution, benchmarks, the risk/savings corridor, provider payments, and waivers and beneficiaries. “In evaluating the Next Generation ACO proposition, organizations need to ask themselves if they have the bandwidth to administer this new, complex, high-risk program,” advised Ansel.

In addition, they proposed a list of 17 key NGACO assessment questions organizations should answer to help determine their readiness for participation. This checklist covers program prerequisites, performance and population health management, among other NGACO areas.

There are currently 20 Next Generation ACOs, most of whom were Pioneer ACOs or Medicare Shared Savings Program (MSSP) participants, the consultants said.

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