CMS Releases New ACO Case Studies

CMS has released three new case studies describing innovative programs from Medicare Accountable Care Organizations (ACOs). The case studies feature ACO initiatives related to:

  • promoting staff development through leadership academies,
  • conducting home visits, and
  • engaging providers.

The case studies highlight ACOs participating in the Next Generation ACO Model and the Medicare Shared Savings Program. Each case study includes detailed results and describes lessons learned by the ACO during implementation. By sharing the stories, CMS hopes to help current and future Medicare ACOs, and other providers and entities, find new ways to make care better, people healthier, and spending smarter.

For more information on these case studies, and to view past case studies and the ACO Toolkit on Care Coordination, please visit the ACO General Information web page.

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.

Next Gen ACO Coalition Applauds CMS’ Continued Commitment to Advancing Performance-Based Risk Models

WASHINGTON, D.C. (Dec. 21, 2018) – The Centers for Medicare and Medicaid Services today reported more than $164 million in Medicare savings – with strong performance on quality metrics – for 44 Next Generation Accountable Care Organizations in 2017.  This builds on savings of $62 million across 18 Next Generation ACOs in 2016.

“We applaud CMS’s continued support for the move to two-sided models in traditional Medicare,” said Next Gen Coalition Executive Director Mara McDermott. “The strong performance of Next Gen ACOs, which accept the highest levels of performance-based risk, is proof positive that this program works and should be strengthened and continued to improve care delivery for patients.”

The full press release is available here.

Next Gen ACO Coalition Comments on Proposed Changes to Medicare Shared Savings Program

On October 16, 2018, The Next Gen Coalition submitted comments on proposed changes to the Medicare Shared Savings Program.  In our letter, we ask that CMS to make the Next Gen program a permanent offering in its Medicare risk portfolio.  We also call on the agency to continue to improve transparency and stability while incentivizing the move to performance-based risk.

The full letter 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.