Archive for the ‘Accountable Care Organizations’ Category

Population Health Tactics to Boost an ACO’s Medicare Annual Wellness Visit Rates

February 9th, 2018 by Patricia Donovan

One of the most important revenue opportunities for primary care physicians, and for population health nurses under their direct supervision, is the Medicare Annual Wellness Visit (AWV), advises Tim Gronninger, senior vice president of development and strategy, Caravan Health. The AWV offers an opportunity to check a number of Medicare quality boxes, including preventive check-ins, vaccinations and health screenings, to help make sure that a beneficiary’s medical needs are being met.

Here, Gronninger suggests ways that physician practices can improve all-important AWV rates.

Much of increasing annual wellness visit rates is about how to manage expectations of the practice and of the patient. You’ll be chasing your tail a lot if you are looking at your data and saying, “Well, these 1,000 patients haven’t had an annual wellness visit. I’m going to make a thousand phone calls, and then I’m going to make a thousand follow-up phone calls to try to schedule them all.”

It is very important for a practice to create a process where you have the time, the space and the plan, so that when a patient comes in the door for an Evaluation and Management (E&M) visit, the patient is handed off seamlessly to a nurse coordinator to complete an annual wellness visit at the same time. Obviously, different patients will require different handling. But we have found a very high acceptance rate from that approach among patients of clients that we work with.

It’s something that many patients take for granted, that their clinician knows this about them already. However, many times, the physician in practice doesn’t know whether the patient is up to date on their mammograms or other types of screenings.

Editor’s Note: Caravan Health’s ACOs saved more than $26 million in the Medicare Shared Savings Program (MSSP) and achieved higher than average quality scores and quality reporting scores in 2016.

Source: Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success

ACO population health

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

In Successful ACOs, Population Health Focus Paves Way for Shared Savings Payouts

January 25th, 2018 by Patricia Donovan

Physician practices toiling in fledgling ACOs and obsessing over shared savings that have not yet materialized, take heart: population health offers multiple revenue streams for accountable care organizations waiting for the “gravy” of accountable care.

“Gravy” is the way Tim Gronniger, senior vice president of development and strategy for Caravan Health, refers to ACO shared savings payouts, which he says can take considerable time to accrue.

“It is literally two years from the time you jump into an ACO before you have even the chance of a shared savings payout,” Gronniger told participants in Generating Population Health Revenue: ACO Best Practices for Medicare Shared Savings and MIPS Success, a January 2018 webcast now available for replay.

Obsessing over shared savings is one of the biggest mistakes hospitals in ACOs can make, he added.

This delay is one reason Caravan Health urges its ACOs to adopt a population health focus, whether pursuing the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) or the Medicare Shared Savings Program (MSSP).

Gronniger’s advice is predicated on his organization’s experience of mentoring 38 ACOs. In 2016, Caravan Health’s ACOs saved more than $26 million in the MSSP program and achieved higher than average quality scores and quality reporting scores, according to recently released CMS data.

Walking attendees through a MACRA primer, Gronniger underscored the challenges of the MIPS program, one of three tracks offered under the Quality Payment Program. “Barring a really exceptional performance on MIPS, you can’t even break even over the next few years on physician compensation,” he said.

In the meantime, ACOs should utilize recently rolled out Medicare billing codes, from the annual wellness visit (AWV) to advanced care planning, to generate wellness revenue. With proper planning, reengineering of staffing and clinical work flows, a practice could generate anywhere from five hundred to one thousand dollars annually per eligible Medicare patient, Gronniger estimates—monies that offset the cost of constructing a sustainable ACO business model.

To back up this population health rationale, Gronniger pointed to data from an ACO client demonstrating the impact of a cohesive PHM approach, including the use of trained population health nurses, on completion rates for preventive screenings. For less top-of-mind screenings like falls assessment and smoking cessation, completion rates rose from negligible to near-universal levels, he said.

“These are recommended sets of screens that are required by CMS, but that also help ACOs with quality measures,” he added.

Gronniger also shared examples of dashboards, scorecards and roadmaps Caravan Health employs to help keep client ACOs on track. An ACO success strategy involves “a lot of dashboarding, checking in, and discussion of problems and barriers, discussion of solutions, and monthly and quarterly measurement and reporting back,” he said.

Beyond coveted shared savings, ACO participation offers significant non-financial benefits, including quality improvements under both MSSP and MIPS standards, availability of ACO-specific waivers, and access to proprietary performance data.

Overall, ACO participation can make providers more attractive both to commercial contractors and to potential patients perusing Physician Compare ratings in greater numbers.

Gronniger ended by weighing in on the recent recommendation by the Medicare Payment Advisory Commission (MedPAC) to repeal and replace the MIPS program.

Assessing MIPS’ Fate: “MedPAC Vote Would Not Affect 2018 Under Any Scenario”

January 18th, 2018 by Patricia Donovan

Tim Gronniger

Tim Gronniger, Senior VP of Development and Strategy, Caravan Health

Amidst healthcare provider outcry over last week’s vote by the Medicare Payment Advisory Commission (MedPAC) to repeal and replace the Merit-based Incentive Payment System (MIPS), an industry thought leader sought to remind physician groups that no change to MIPS is imminent.

“MedPAC is an advisory body, not a legislative one,” said Tim Gronniger, senior vice president of development and strategy for Caravan Health, a provider solutions for healthcare organizations interested in value-based payment models, including accountable care organizations (ACOs).

“Congress would need to adopt MedPAC’s recommendations in order for the changes to go into effect. It is reasonable to expect MIPS to evolve over time, but that evolution will be gradual. [MedPAC’s vote on MIPS] would not affect 2018 under any scenario.”

Gronniger made his comments during Generating Population Health Revenue: ACO Best Practices for Medicare Shared Savings and MIPS Success, a January 2018 webcast sponsored by the Healthcare Intelligence Network and now available for rebroadcast.

Earlier this month, MedPAC voted 14-2 to scrap the MIPS program, describing it in a presentation to members as “burdensome and complex.” According to the advisory commission, “MIPS will not succeed in helping beneficiaries choose clinicians, helping clinicians change practice patterns to improve value, or helping the Medicare program to reward clinicians based on value.”

MedPAC is expected to pass this recommendation along to Congress in coming months, along with a proposed alternative. In MIPS’s place, MedPAC is suggesting a voluntary value program (VVP) in which “group performance will be assessed using uniform population-based measures in the categories of clinical quality, patient experience, and value.”

MGMA’s Anders Gilberg reacts to the MedPAC ruling.

Among the provider groups reacting to MedPAC’s actions was the Medical Group Management Association (MGMA). In a Twitter post, Anders Gilberg, MGMA’s senior vice president for government affairs, called the VVP alternative “a poor replacement,” claiming it “would conscript physician groups into virtual groups and grade them on broad claims-based measures.”

The day prior to the January 11 vote, MGMA had reached out in a letter to Seema Verma, administrator for the Centers for Medicare & Medicaid Services (CMS), requesting CMS to immediately release 2018 Merit-based Incentive Payment System (MIPS) eligibility information, which it called “vital to the complex clinical and administrative coordination necessary to participate in MIPS.”

Infographic: Medicare Advantage Trends

January 10th, 2018 by Melanie Matthews

As medical groups and large systems transition to risk-based models, they expect nearly 60 percent of federal revenues will come from risk-based products (bundled payment, Medicare Advantage (MA), Medicaid Managed Care Organizations, and Medicare Accountable Care Organizations) by 2019, according to a new infographic by AMGA.

The infographic shows the anticipated the growth of MA as well as what this means for healthcare providers.

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare IndustryGiven the powerful patterns disrupting healthcare, what will it take to succeed as a high-velocity healthcare organization in 2018?

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare Industry, HIN’s 14th annual business forecast, is designed to support healthcare C-suite planning as leaders react to presidential priorities and seek new strategies for engaging providers, patients and health plan members in value-based care.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

2018 Success Strategy: Differentiate to Survive Next Wave of Healthcare

January 5th, 2018 by Patricia Donovan

Are supermarkets the next wave of healthcare?

Perhaps not, but if a health insurer can move into the community pharmacy, why not the local grocery store?

On the heels of the recent non-traditional CVS Health-Aetna merger and amidst other swirling consolidation rumors, industry thought leaders are encouraging healthcare organizations to embrace similar partnerships and synergies.

And given the presence of pharmacies inside many supermarkets, “there is potential for greater synergies around what we eat, what we buy and how our healthcare is actually purchased or delivered,” suggests David Buchanan, president of Buchanan Strategies.

“The bonanza [from this merger] might be where data can be shared between CVS’s customers and Aetna’s customers and whether we can steer those CVS customers to Aetna,” he added.

Buchanan and Brian Sanderson, managing principal of healthcare services for Crowe Horwath, sketched a roadmap to help healthcare providers and payors navigate the key trends, challenges and opportunities that beckon in 2018 during Trends Shaping the Healthcare Industry in 2018: A Strategic Planning Session, a December 2017 webinar now available for rebroadcast.

Key guideposts on the road to success: data analytics, consolidation, population health management, patient and member engagement, and telemedicine, among other indicators. Also, organizations shouldn’t hesitate to test-drive new roles in order to differentiate themselves in the marketplace.

“If you are not differentiated, you will not survive in what is a very fluid marketplace,” Sanderson advised.

Honing in on the healthcare provider perspective, Sanderson posed five key questions to help shape physician, hospital and health system strategies, including, “What are the powerful patterns?” Industry mergers, an infusion of private equity money into areas like ambulatory care and emerging value-based payment models fall into this category, he suggested.

These patterns were echoed in four primary trends Sanderson outlined as shaping the direction of the healthcare market, which faces an increasingly “impatient” patient. “I could tell you the market wants care everywhere,” he said. “In the same way we have become impatient with our commoditized goods, so have patients become impatient with accessing care.”

Among these trends are “unclear models of reimbursement,” he noted, adding that after a self-imposed “pause” relative to healthcare reimbursement at the start of a new presidential administration, the industry is ready to “restart with some new sponsors now.”

Notably, Sanderson advised providers to embrace population management. “Don’t think population health, think population management. It’s no longer just the clinical aspects of a patient’s or a population’s health. It’s the overall management of their well-being.”

Following Sanderson’s five winning strategies for healthcare provider success, David Buchanan outlined his list of hot-button items for insurers, which ranged from the future of Obamacare and member engagement to telemedicine, healthcare payment costs and models and trends in Medicare and Medicaid.

Healthcare payors should not underestimate the value of engaging its members, who today possess higher levels of health literacy, he stated. “The member must be an integral part of healthcare transactions, as are the provider, the facility and the insurer. The member must have a greater level of personal responsibility and engagement in the process.”

Offering members wearable health technologies like fitness trackers is one way insurers might engage individuals in their health while creating ‘stickiness’ and member allegiance to the health plan.

Telemedicine, the fastest growing healthcare segment, is another means of extending payors’ reach and increasing profitability, he adds. “Telemedicine is not just for rural health settings anymore, but is finding another subset of adopters among people who can’t fit a doctor’s visit into their busy schedule.”

Payors should expect some competition in this area. “I believe the next wave [of telehealth] will be hospitals expanding into local telehealth services as a lead-in to their local clinics,” Buchanan predicted.

The use of artificial intelligence (AI) and robotics in healthcare is growing, but Buchanan and Sanderson agree that adoption will be slow. On the other hand, expect more collaboration between digital players like Amazon, Google and Apple and larger health plans.

“You will see [synergies] when you can put those two players together: the company that can bring the technology to the table as well as those companies that bring the users to the table,” concluded Buchanan.

Listen to a HIN HealthSounds podcast in which David Buchanan predicts the future of mega mergers in healthcare, the impact of the CVS-Aetna alliance on brand awareness, and the real ‘bonanza’ of the $69 billion partnership, beyond bringing healthcare closer to home for many consumers.

Guest Post: Are You Preparing to Fail Healthcare Compliance in 2018?

December 19th, 2017 by Tim Feldman and Darci L. Friedman

A 2018 roadmap to healthcare compliance should focus on cybersecurity, vendor management and telehealth.

As the year winds down, we see numerous lists of priorities healthcare organizations should focus on in the coming year. However, if you are looking to those end-of-year lists for guidance on what your organization should pay attention to in 2018, you are already behind. If you do find yourself playing catch-up, drafting your 2018 compliance work plan is the best place to start.

As the roadmap for your compliance efforts throughout the year, your annual work plan should indicate key high-risk areas. The Office of Inspector General (OIG) of the Department of Health & Human Services (HHS) has indicated that developing an annual compliance work plan is integral to the administration of an effective compliance program (Measuring Compliance Program Effectiveness – A Resource Guide).

The annual work plan and compliance program administration are but one portion of what is required for an organization to have a robust and effective compliance program. The required elements of a compliance program are the following:

  • Standards, Policies and Procedures;
  • Compliance Program Administration;
  • Screening and Evaluation of Employees, Physicians, Vendors and Other Agents;
  • Communication, Education and Training;
  • Monitoring, Auditing and Internal Reporting Systems;
  • Discipline for Non-Compliance; and
  • Investigations and Remedial Measures.

These elements provide a broad framework for your organization to identify risk, proactively remediate and provide a response mechanism to mitigate when there is an exposure. Working the plan and program throughout the year helps your organization achieve a state of ongoing readiness.

Cybersecurity

Cybersecurity is one item that will likely factor more heavily in your work plan, and appropriately so. Last June, the HHS Health Care Industry Cybersecurity Task Force released a report on improving cybersecurity in the industry. The Task Force concluded that cybersecurity, at its core, is a patient safety issue and a “public health concern that needs immediate and aggressive attention.”

Some of the areas to address in the broader realm of cybersecurity include:

  • Ransomware;
  • Email security, including phishing;
  • Internet of Things (IoT) and devices;
  • Bring your own device (BYOD); and
  • Medical identity theft.

As the Task Force report notes, cybersecurity must be thought about across the continuum of care in your organization. Work to shift the culture and thinking that cybersecurity is simply a technology issue, of concern only to the IT department.

Do this by implementing policies and procedures for key cybersecurity issues and then communicating them across the organization. Follow that with training, including everyone in your organization, from staff to board members. The training should: define cybersecurity; explain how it may manifest in the organization, and address your policies and procedures, making it evident to all what they can and cannot do and how to respond.

Third-Party Vendor Management

The outsourcing of services to third-party vendors is increasingly common and for good reason. Such relationships offer great benefits, but at the same time, these relationships also carry legal, financial, reputational and compliance-related risks. Here are seven questions to evaluate your third-party vendor relationships:

  • Does your organization, as a covered entity (CE) under HIPAA, have a vendor compliance program to help you identify, manage and report on these risks?
  • Do you review and assess your vendors’ risk profile?
  • Are you familiar with each vendor’s hiring practices?
  • Do you know which vendors’ products connect to other IT systems that contain critical data, including protected health information (PHI)?
  • Do you have insight into each vendor’s information security and data privacy capabilities?
  • Do you know with which vendors you have a business associate agreement (BAA)?

For many healthcare organizations, the answer to several of these questions is likely “no,” which creates risk for those organizations. The OIG’s position is clear: healthcare entities have a responsibility to proactively identify, assess and manage the risks associated with their vendor relationships.

All vendors are NOT created equal. A good starting point in managing an effective and efficient third-party compliance program is to perform a risk-ranking of vendors based on their access to critical assets or information. By segmenting your vendor population into “risk tiers” you can focus limited resources on the most serious exposures.

Components of third-party compliance assessment should include, among other things:

  • Due diligence (background, reputation, strategy);
  • Knowledge of, and compliance with, security and privacy requirements;
  • Operations and internal controls (policies and procedures);
  • Workforce controls, background and exclusion checks; and
  • Training and education.

And, of course, with every vendor that meets the criteria of a Business Associate, ensure that a written BAA is in place. BAAs can be complex and are often daunting, but they must be carefully negotiated and acknowledged by both parties.

By ensuring your vendors have strong compliance programs in place and that they are following through on the BAA requirements, your organization is meeting its compliance obligations and doing its best to minimize its risks.

Telehealth

The compliance concerns related to the delivery of care via telehealth are numerous and include the following:

  • Licensing;
  • Credentialing;
  • Security;
  • Regulatory requirements for billing; and
  • Fraud and abuse.

An area to focus some attention on is payment under federal healthcare programs. The OIG currently has two active work items on telehealth, one for Medicaid and one for Medicare. Both of the items relate to the propriety of payment for telehealth services.

If your organization provides telehealth services, consider conducting a risk assessment to determine if you have any exposure in the area. Risk assessments are not strictly one of the 7 required elements of a compliance program, but they are often referred to as the “8th Element” given the focus on them in the Federal Sentencing Guidelines and OIG documents.
Risk assessments, along with the other elements of a compliance program, provide your organization the means to identify, prioritize, remediate and/or mitigate the myriad on-going risks it will encounter. If you are not working your compliance program and specific risk areas throughout the year, you are failing to adequately prepare for an event. By failing to prepare, as one wise man said, you are preparing to fail.

About the Authors: Tim Feldman is Vice President and General Manager of Healthcare Compliance & Reimbursement at Wolters Kluwer Legal & Regulatory U.S. He oversees product development across a vast suite of practice tools and workflow solutions to help professionals stay ahead of regulatory developments and effectively manage compliance activities. Darci L. Friedman, JD, CHPC, CSPO, PMC-III, is the Director of Content Strategy & Author Acquisitions for Healthcare Compliance, Coding & Reimbursement at Wolters Kluwer Legal & Regulatory U.S. She is responsible for supporting the overall strategy for developing new content and features, innovating new product models, and recruiting top content contributors.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

LVHN Portal Places Healthcare Control in Patients’ Hands, Liberates Staff

November 30th, 2017 by Patricia Donovan

patient portal rolloutConsumers accustomed to communicating, shopping, banking and booking travel online increasingly expect those same conveniences from their healthcare providers.

And as Lehigh Valley Health Network (LVHN) has learned, despite the myriad of benefits a patient portal offers, the most important reason to incorporate this interactive tool into a physician practice is because patients want it.

“As much as we emphasize the marketing aspect of [the portal], having a nice, functional technology that we get in other aspects of our life has really been an enabler,” notes Michael Sheinberg, M.D., medical director, medical informatics, Epic transformation at LVHN. Many LVHN patients found the portal on their own, independent of the tool’s formal introduction, he adds. “Patients really wanted this. Our patients want to be engaged, they want to have access, and they want to own their medical information.”

Dr. Sheinberg and Lindsay Altimare, director of operations for Lehigh Valley Physician Group at LVHN, walked through the rollout of the LVHN portal to its ambulatory care providers during Patient Portal Roll-Out Strategy: Activating and Engaging Patients in Self-Care and Population Health, a November 2017 webinar now available for rebroadcast.

The 2015 launch of LVHN’s patient portal and its continued user growth has earned it the distinction of being the fastest growing patient portal on the Epic® platform.

As Ms. Altimare explained, LVHN first launched its portal with limited functionality in February 2015 as part of the Epic electronic health record that had gone live two years earlier. But even given the portal’s limited feature set, LVHN quickly recognized the tool’s potential to enhance efficiency, education, communication and revenue outside of traditional doctor’s office visits.

At its providers’ request, however, LVHN first piloted the portal within 14 of its 160+ physician practices, using feedback from providers in the two-month trial to further tweak the portal before next rolling it out to its remaining clinicians, and finally to patients.

LVHN supported each rollout phase with targeted marketing and education materials.

Today, LVHN patients and staff embrace the functionality of the portal, which offers an experience similar to that of an online airline check-in. Via the portal, LVHN patients can self-schedule appointments, complete medical questionnaires and forms, even participate in select e-visits with physicians—all in the comfort and privacy of their own homes.

Not only are about 45 percent of LVHN’s 420,000 patients enrolled in the portal, but self-scheduling doubled in the first six months of use. Additionally, upon examining a segment of portal participants over 12 months, LVHN identified a steady rise in portal utilization for common tasks like medication renewals and medical history completion.

The portal “liberates our patients from the need to access our providers in the traditional way,” says Dr. Sheinberg. Appreciation of this freedom is reflected in improved patient experience scores, he adds.

“The portal is a patient satisfier, and certainly a staff satisfier, because it reduces patient ‘no-shows’ and liberates our staff from more manual processes, putting them in the hands of our patients.”


4 Ways CMS 2018 Quality Payment Program Supports ‘Patients Over Paperwork’ Pledge

November 6th, 2017 by Patricia Donovan

“Patients Over Paperwork” is committed to removing regulatory obstacles that get in the way of providers spending time with patients.

Year 2 of the CMS Quality Payment Program promises continued flexibility and reduced provider burden, according to the program’s final rule with comment issued by the Centers for Medicare and Medicaid Services (CMS) last week.

The Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a quality payment incentive program for physicians and other eligible clinicians that rewards value and outcomes in one of two ways: through the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

A QPP Year 2 fact sheet issued by CMS highlights 2018 changes for providers under the QPP’s MIPS and APM tracks. The Year 2 fact sheet noted that stakeholder feedback helped to shape policies for QPP Year 2, and that  “CMS is continuing many of its transition year policies while introducing modest changes.”

In keeping with the federal payor’s recently launched “Patients Over Paperwork” initiative, QPP Year 2 reflects the following changes:

    • More options for small practices (groups of 15 or fewer clinicians). Options include exclusions for individual MIPS-eligible clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries, opportunities to earn additional points, and the choice to form or join a virtual group.
    • Addresses extreme and uncontrollable circumstances, such as hurricanes and other natural disasters, for both the 2017 transition year and the 2018 MIPS performance period, by offering hardship exception applications and limited exemptions.
    • Includes virtual groups as another participation option for Year 2. A virtual group is a combination of two more taxpayer identification numbers (TINs) made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together ‘virtually’ (no matter specialty or location) to participate in MIPS for a performance period of a year. A CMS Virtual Groups Toolkit provides more information, including the election process to become a virtual group.
    • Makes it easier for clinicians to qualify for incentive payments by participating in Advanced APMs that begin or end in the middle of a year. Updated QPP policies for 2018 further encourage and reward participation in APMs in Medicare.
  • CMS describes its Patients Over Paperwork effort as “a cross-cutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. This effort emphasizes a commitment to removing regulatory obstacles that get in the way of providers spending time with patients.”

    Healthcare Hotwire: Social Determinants of Health

    October 25th, 2017 by Melanie Matthews

    Healthcare risk sharing requires a new focus on the whole patient…addressing all of the factors that could impact the health of accountable populations.

    Evidence is mounting that social determinants of health—social, economic and environmental factors that impact quality of life—significantly influence population health.

    Initiatives such as CMS’ Accountable Health Communities Model and other population health platforms encourage healthcare organizations to tackle the broad range of social, economic and environmental factors that shape an individual’s health. Mission Health recently attributed its success in CMS’ Medicare Shared Savings Program to its care coordination model that addresses the whole person.

    And 2015 research by Brigham Young University found that the social determinants of loneliness and social isolation are just as much a threat to longevity as obesity.

    In the new edition of Healthcare Hotwire, you’ll get details on how social health determinants impact patient populations and what healthcare organizations are doing to address these factors.

    HIN’s newly launched Healthcare Hotwire tracks trending topics in the industry for strategic planning. Subscribe today.

    2016 ACO Results: Majority of Next Generation and Pioneer ACOs Earn Shared Savings

    October 20th, 2017 by Patricia Donovan

    Six of eight Pioneer ACOs and eleven of eighteen Next Generation ACOs earned shared savings in separate initiatives in 2016, according to newly released quality and financial data from the Centers for Medicare and Medicaid Services (CMS).

    In 2016 Performance Year Five of the Pioneer ACO program, one of several new accountable care organization (ACO) payment and service delivery models introduced by CMS to serve a range of provider organizations, only Monarch HealthCare and Partners HealthCare were not among shared savings earners.

    Banner Health Network emerged as the top 2016 Pioneer ACO performer, earning nearly $11 million in shared savings based on care provided to its more than 42,000 beneficiaries.

    In order to receive savings or owe losses in a given year, Pioneer ACO expenditures must be outside a minimum corridor set by the ACO’s minimum savings rate (MSR) and minimum loss rate (MLR).

    The Pioneer ACO model is designed for healthcare organizations and providers already experienced in coordinating care for patients across care settings. It allowed these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with but separate from the Medicare Shared Savings Program (MSSP).

    The Pioneer ACO Model began with 32 ACOs in 2012 and concluded December 31, 2016 with eight ACOs participating.

    Meanwhile, at the conclusion of 2016 Performance Year One of the Next Generation ACO model, Baroma, Triad and Iowa Health topped the list of ACO earners in this program, with each organization accumulating more than $10 million shared savings.

    Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program, CMS’s Next Generation ACO Model sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.

    According to a CMS fact sheet, 18 ACOs participated in the Next Generation ACO Model for the 2016 performance year, and 28 ACOs are joining the Model for 2017, bringing the total number of Next Generation ACOs to 45. The Next Generation ACO Model will consist of three initial performance years and two optional one-year extensions.

    CMS’s ACO models are one of seven Innovation categories designed to incentivize healthcare providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes that provide for coordinated care, high quality and efficient service delivery.