CMS Unveils ‘Next Generation’ ACO Model for Patients, Providers
On Tuesday, CMS unveiled the Next Generation Accountable Care Organization Model, which it hopes will provide an attractive alternative payment model for providers wary of existing models, MedPage Today reports.
Patrick Conway, CMS CMO and deputy administrator for innovation and quality, said CMS, after launching its Medicare Shared Savings and Pioneer ACO programs, "started to hear from stakeholders that [said], 'You really need a next-generation model'" (Frieden, MedPage Today, 3/10).
Details on New Model
According to Modern Healthcare, the new model uses a combination of fee-for-service and capitation (Evans, Modern Healthcare, 3/10). It creates four payment systems and two risk tracks for its participants, including one with almost full risk (Williams, Healthcare Dive, 3/10).
In a blog post for CMS, Conway wrote that the Next Generation ACO Model "sets more predictable financial targets." He explained, "To support increased risk, ACOs will have a stable, predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure to provide high quality care to patients" (Conway, CMS blog post, 3/10).
In a significant departure from existing ACO options, patients under the new model will be able to voluntarily sign up to participate in the ACOs. In exchange, they will pay reduced or no copayments for certain services, such as primary care visits (Modern Healthcare, 3/10). Participation in the ACO does not limit patients' choice of providers, according to Conway.
CMS will accept applications for the Next Generation ACO Model in two rounds that conclude on June 1, 2015, and June 1, 2016, respectively. To be eligible, provider groups must serve at least 10,000 Medicare beneficiaries. Conway predicted that Pioneer ACOs and Medicare Advantage providers might be interested in the new model (MedPage Today, 3/10).
The program is slated to launch in January 2016 and expand the following year to reach between 15 and 20 ACOs, Conway said (Modern Healthcare, 3/10).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.