Posts Tagged ‘Next Generation ACO’

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.

As Next Generation ACO Deadlines Loom, Organizations Assess Risk Tolerance

April 11th, 2016 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.

Infographic: MSSP and Next Generation ACO Risk Scenarios

March 21st, 2016 by Melanie Matthews

As healthcare shifts its focus to improved care, healthier populations and reduced costs, accountable care organizations (ACOs) stand to make a lasting, positive impact on the United States healthcare system and healthcare organizations’ bottom lines, according to a new infographic by Greenway Health.

Participation in the Medicare Shared Savings Program (MSSP) has helped ACOs earn shared savings—but what percentage of savings can you earn and what risk do you assume for participating? The infographic examines the features of each track of the MSSP program, including the Next Generation ACO Model.

With the nation’s leading accountable care organizations already testing the waters with CMS’ newest value-based reimbursement opportunity, the Next Generation Accountable Care Organization Model, healthcare organizations are evaluating how this new opportunity aligns with their value-based contracting strategy. With a looming application deadline for a 2017 start for the next round of Next Generation ACOs, the clock is ticking. And, with one approved Next Generation ACO, River Health ACO, already departing the program effective February 1st, the “Go-No Go” decision has become even more critical.

During Next Generation ACO: An Organizational Readiness Assessment, a 60-minute webinar on April 5, 2016 at 1:30 p.m. Eastern, Healthcare Strategy Group’s Travis Ansel, senior manager of strategic services, and Walter Hankwitz, senior accountable care advisor, will provide a value-based, risk contract roadmap to determine organizational readiness for participation in the Next Generation ACO Model in particular and in risk-based contracts in general.

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CMS Postpones LOI Deadline to May 2, Readies for Next Wave of ‘Next Generation ACO’ Participants

March 10th, 2016 by Patricia Donovan

Update: On March 11, 2016, the Centers for Medicare and Medicaid Services (CMS) pushed back the deadline for letters of intent for 2017 Next Generation ACO participation to May 2, 2016.

ACO

April 1 is the deadline to submit a letter of intent to participate in the Next Generation ACO Model in 2017.

Letters of intent from healthcare organizations interested in applying to the Next Generation ACO Model for the January 1, 2017 start date must be submitted by April 1, 2016, according to an update from the Centers for Medicare and Medicaid Services.

The letter of intent (LOI) as well as more information about CMS’s newest accountable care organization model, including dates and times for Application Open Door Forums, can be found on the Next Generation ACO Model web page.

Only organizations that submit an LOI will be able to complete an application. Even applicants that submitted an application previously but are not participating in the Next Generation ACO Model for 2016 must complete and submit an LOI if they wish to apply to participate in the Next Generation ACO Model beginning in 2017, CMS stated.

Subsequent to the organization’s LOI, applications for 2017 Next Generation ACOs will be due in two parts:

  • The narrative portion is due May 25, 2016; and
  • The Participating Provider list is due June 3, 2016.

If an organization plans to submit more than one LOI, it should use a different email address for the primary contact listed on each LOI submission, CMS said in its Next Generation ACO LOI and application FAQs.

In 2016, there are currently 21 ACOs participating in the Next Generation ACO Model, an initiative for ACOs that are experienced in coordinating care for populations of patients. The Next Generation ACO model allows these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer and Shared Savings Program (MSSP) models. The goal of the Next Generation ACO model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.

2015 metrics from the Healthcare Intelligence Network (HIN) found that one-fifth of healthcare organizations expect to participate in CMS’ new ‘Next Generation’ ACO Model in the future.

View an infographic on the Next Generation ACO model.

An April 5th webinar hosted by the Healthcare Intelligence Network will provide a value-based, risk contract roadmap to determine organizational readiness for participation in the Next Generation ACO Model in particular and in risk-based contracts in general. Click here for more details.

HINfographic: Next Generation ACO Model

November 18th, 2015 by Melanie Matthews

One fifth of healthcare organizations are gearing up to participate in CMS’ new ‘Next Generation’ ACO Model in the year ahead, according to 2015 metrics from the Healthcare Intelligence Network (HIN). In the Next Generation ACO model, participants can take on greater financial risk than those in current Medicare ACO initiatives, while also potentially sharing in a greater portion of savings.

A new infographic by HIN examines ACO participation by model type, the top challenges to ACO creation, current and planned ACO participation levels and success criteria.

2015 Healthcare Benchmarks: Accountable Care Organizations Even before CMS published its agenda for moving Medicare into value-based payment models like the accountable care organization (ACO), the number of public and private ACOs had exceeded 700, by a Leavitt Partners estimate. Already, more than 20 percent of healthcare organizations plan to participate in Medicare’s latest accountable care model, the Next Generation ACO, in the coming year.

Support for CMS’s latest alternative payment offering is just one of the ACO metrics contained in 2015 Healthcare Benchmarks: Accountable Care Organizations. HIN’s fourth annual compendium of metrics on ACOs captures how ACOs are faring in an industry rapidly shifting away from fee for service to one that rewards quality, the patient and population experiences, and cost efficiencies. Click here for more information.

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Are Multi-Specialty Physician Groups ‘Next Generation’ to Transition to ACOs?

March 26th, 2015 by Cheryl Miller

In another step towards advancing models of care that reward value over volume, HHS recently announced the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, a new initiative designed to move an increasing percentage of Medicare payments into models that support value-based care, and which supports a number of tools including telehealth and post-discharge home services.

With their built-in cadre of healthcare providers, multi-specialty physician groups (referred to here as physician groups), which comprised about a tenth of survey respondents to the Healthcare Intelligence Network’s third annual Accountable Care Organization survey administered in 2013, would seem ideally placed to transition to accountable care organizations. Percentage-wise, this sector has the highest rate of existing ACOs (57 percent participating in ACOs versus 34 percent of overall respondents) and twice the rate of participants in the CMS Pioneer ACO program (25 percent versus 13 percent).

Other characteristics of this sector follow.

In other deviations from the norm, twice the number of physician group-reported ACOs favor the hybrid FFS + care coordination + shared savings payment model (75 percent of physician-group ACOs versus 37 percent of overall respondents).

More than half of ACOs in this sector are administered by independent physician associations (IPAs), and most are smaller than the hospital-sized ACOs reported above, with three-quarters reporting a physician staff of less than 100. These ACOs benefit from having specialists on board in greater numbers to help with care coordination of the chronically ill (100 percent include specialists, versus 71 percent overall).

They also unanimously include nurse practitioners (versus 90 percent of overall respondents) and with 50 percent including clinical psychologists in the ACO (versus 42 percent overall), are a little further along on the path of integrating behavioral health into the accountable care initiative.

Cognizant of the full care continuum, these IPA-led ACOs are almost twice as likely as overall respondents to include skilled nursing facilities (50 percent versus 29 percent overall) and hospice (75 percent versus 42 percent overall) in their ACOs.

Perhaps because their organizational structure lends itself to the ACO model, the majority of this sector—75 percent—needed less than year to launch its accountable care organization (versus 29 percent of overall respondents, whose comfort level was between 18 months and two years).

These ACOs seem to have all the clinical pieces in place, reporting near-unanimous usage of evidence-based care, case management, care transition management and population health management. They are also unanimous in the review of clinical outcomes as an ACO success measurement, and much more likely than their counterparts to consider provider satisfaction in program evaluation (50 percent of physician group-led ACOs, versus 32 percent of overall respondents).

Technology-wise, however, there’s some catch-up to be done here: only three-fourths of responding physician groups report the use of EHRs and patient portals, versus near-global usage levels reported in other sectors. This could explain why this sector was three times more likely to report technology as a barrier to ACO creation

Source: 2013 Healthcare Benchmarks: Accountable Care Organizations

http://hin.3dcartstores.com/2014-Healthcare-Benchmarks-Embedded-Case-Management-_p_4985.html

2013 Healthcare Benchmarks: Accountable Care Organizations documents the numerous ways in which accountable care is transforming healthcare delivery, particularly in the area of care coordination, where the ACO model has had the greatest impact for this year’s respondents.