When the Centers for Medicare & Medicare Services (CMS) unveiled its Next Generation ACO program in January 2016, accountable care organizations (ACOs) that were in either of the government’s other two ACO models—the Pioneer ACO model and the Medicare Shared Savings Program (MSSP) model—had a leg up, as the newer model was built on many of the accountable care concepts and principles as the elder two initiatives.
As such, for ACOs like Newton, Mass.-based Atrius Health that were in the Pioneer model, which expired at the end of 2016, the federal ACO options going forward in 2017 were either MSSP or Next Gen. For Atrius Health, only one of six Pioneer ACOs to generate shared savings in 2015, the Next Gen model was the right move, since, as Emily Brower, the organization’s vice president of population health puts it, Next Gen “is most like the Pioneer [program], as it included and was built around many of the things that worked in that model.” Brower also notes that the Next Gen model is located in the Center for Medicare & Medicaid Innovation (CMMI), “where we had developed some good collaborative relationships with the team, and that we felt the center would help shape other models going forward. So this was the right path for us,” she says.
Atrius Health, whose participating Pioneer ACO clinicians serve more than 25,000 Medicare beneficiaries in the central and eastern parts of Massachusetts, achieved a 95 percent quality score from CMS and saved Medicare $6.8 million compared to its target, returning $4.4 million in savings to the organization in 2015. When CMS announced the launch of the Next Gen ACO model in 2016, it initially had 21 participants—15 of those which came from either the Pioneer or MSSP models—but then the agency started accepting applications for 2017 participants, and it was announced early on this year that Atrius Health was officially accepted. CMS recently said that the number of 2017 Next Gen ACO participants is 45; the federal agency also announced that 2018 Next Gen participants will qualify as Advanced Alternative Payment Models (APMs) under the Quality Payment Program within the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Brower notes that having Next Gen count as a qualified advanced APM was something that attracted Atrius Health, but she adds that being in the MSSP model also would have qualified, as she understands it. “Participating in an ACO model does mean that we can check the box for [the Quality Payment Program] and not have to do two separate processes,” she says. But she adds that a possible complication could occur when an organization has to do a secondary process for the providers that joined the ACO after the list of participants was submitted to CMS. She explains: “CMS is working with us so we could add additional providers to the APM list during the year, and I believe that will happen.” [Upon follow-up, Brower confirmed Atrius Health provider additions will be included in its NextGen ACO for MACRA purposes.] “That will limit the number of providers that an organization will have to do supplemental or MIPS [Merit-Based Incentive Payment System] reporting for. But there will always be some providers who you have a gap for, as we hire people all year long.”
For the Next Gen model, as CMS said at the time of the initiative’s launch, “Participants will have the opportunity to take on higher levels of financial risk—up to 100 percent risk—than ACOs in current initiatives. While they are at greater financial risk they also have a greater opportunity to share in more of the Model’s savings through better care coordination and care management.”
Rather than a substantial roadblock, Brower sees this as a great opportunity for Atrius Health. “Eighty percent of our revenue is in full risk. So this model is more like what we do elsewhere. And it gives us more of a 1:1 correlation in terms of the effort we’re putting in and the reward gained,” she says. “So rather than a dollar you save going through a process where a piece goes here and a piece there, and you share that with CMS, [for this model], CMS takes a discount of their savings off the top and then 100 percent of the risk or reward lies with the ACO against that discounted benchmark. That’s more typical of the other payer contracts we have, so that works for us,” Brower attests.
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