Codify Success of Next Gen Model into Regulatory Full-Risk Offering in Pathways for Success

WASHINGTON, D.C. (May 30, 2019) – The Next Generation (Next Gen) Accountable Care Organization Coalition represents 21 of the existing Next Gen ACOs. We appreciate the opportunity to weigh in as you continue to design and implement the future portfolio of performance-based risk models.

The Next Generation ACO model has demonstrated that organizations can be successful in taking two-sided financial risk. The evaluation of the first performance year of Next Gen resulted in an estimated $63 million in net savings or a 1.1 percent decline in Medicare spending while maintaining quality for patients.

Next Gens have successfully implemented care management programs that are improving care for seniors in traditional Medicare. For example, Next Gens have engaged beneficiaries in transitions of care programs, disease management, social work and health enhancement programs, as well as strengthening relationships with primary care providers. As a result of these care redesign initiatives, Next Gens have achieved reduced readmissions rates, reduced non-emergent use of the emergency department; and improved quality for beneficiaries.

The full letter is available here.

Permanence for the Next Generation Accountable Care Organization (NGACO) Model

WASHINGTON, D.C. (May 30, 2019) – The undersigned organizations write to encourage the Department of Health and Human Services to expand the duration and scope of the NGACO model to be a permanent, voluntary offering in the performance-based risk model portfolio beginning with the 2021 performance year. Participants in the NGACO model have demonstrated success in terms of controlling costs for Medicare and improving care for seniors. Extending the availability of this model will allow additional providers to pursue the transition to improved care outcomes and greater levels of financial accountability.

We believe there is sufficient evidence of the model successfully meeting the criteria under Section 1115A authority to expand its duration and scope of participation. However, we call on the agency to begin the work of incorporating the most successful features of the NGACO program into Pathways to Success immediately through regulation (as the agency did with the Pioneer ACO program).1 Making this option available for future participation will support a smooth transition into performance-based risk arrangements for more providers while also building on the lessons learned from successful Innovation Center pilots.

The full letter is available here.