CMS Releases Next Gen Model Evaluation

The Centers for Medicare & Medicaid Services (CMS) released the first annual report on the Next Generation Accountable Care Organization (ACO) model.  The report provides results from the 18 active Next Gens who participated beginning January 2016.  Key findings from the report showed that Next Gen ACOs reduced spending by approximately $100 million (a 1.7 percent reduction), or $62 million after adjusting for shared savings/shared losses.  The savings appear to be associated primarily with reductions in hospital and skilled nursing facility costs.  Notably, over half the model’s cost and utilization decline was generated by four of the 18 Next Gens.

The Next Gen ACO model was intended to test whether stronger financial incentives could improve care and reduce costs for traditional Medicare beneficiaries.  ACOs in the Next Gen model assume 80-100 percent two-sided risk and have additional flexibilities compared to other Medicare ACOs.  The ACO program is slated to run through December 31, 2020.  The Next Gen ACO model is one of a handful of qualifying Advanced Alternative Payment Models under Medicare’s Quality Payment Program.

The full report is available here.

The findings at a glance are available here.

The CMS press release is available here.

CMS Releases Proposed Rule Overhauling Medicare Shared Savings Program

The Centers for Medicare & Medicaid Services (CMS) released a long-awaited proposed rule that would revamp the Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs).  Among key changes, the rule reduces the amount of time ACOs can spend in upside-only arrangements (where they are eligible to share in savings but not at risk for repaying the government if they overspend their targets).  The rule also reduces the amount of savings an organization can share in when participating in an upside-only arrangement, and it proposes implementing several provisions of the Bipartisan Budget Act of 2018, including expanded use of beneficiary incentives, telehealth, and other flexibilities.

The proposed rule is available here.

The CMS fact sheet is available here.