News

Next Gen Coalition to Co-Host Capitol Hill Briefing on Value Based Care

Next Gen ACO Coalition to Co-Host Capitol Hill Briefing on Value Based Care

Washington D.C. (Apr, 2021) – Value-based healthcare policy developments have restructured the healthcare landscape to emphasize the delivery, measurement, and outcomes of care. Over the past ten years millions of Medicare beneficiaries have been served by innovative payment models. These innovative payment approaches have also been deployed within private coverage. Innovative healthcare providers are successfully delivering improved patient care at lower costs through two-sided risk-based payment models like bundled payment arrangements and accountable care organizations.

Next Gen will co-host a virtual educational boot camp on April 8, 2021 focused on understanding and implementing value-based healthcare payment and delivery system reform. You’ll also hear directly from some of the nation’s leading providers and health systems on the barriers they’ve overcome transitioning to alternative payment models and key actions Congress can take to ensure the success of value-based payment initiatives.

Fee-for-Service to Value: 10 Years of Transforming Healthcare

Thursday, April 8, 2021
12:00 p.m. – 1:15 p.m. ET
Please share with any interested parties.
To RSVP, please click here.

Next Gen ACO Coalition Applauds Model Savings of $559 Million in 2019

Next Gen ACO Coalition Applauds Model Savings of $559 Million in 2019

Washington D.C. (Jan, 2021) – Next Generation Accountable Care Organizations (Next Gen ACOs) collectively saved $559 million last year, according to partial performance data from the Centers for Medicare & Medicaid Services (CMS). In addition, Next Gens maintained an average quality score of 93.7%. The release shows financial and quality performance for 37 of the 41 Next Gens participating in the model in 2019.

The Next Gen ACO model tests the highest levels of financial risk, reward, and accountability in traditional Medicare. Since 2016, Next Gen ACOs have been leading the health care system’s transformation from volume to value. The model is currently set to sunset at the end of 2021. The Next Gen ACO Coalition is calling on the new Administration to make this model a permanent part of the CMS value-based care portfolio.

The press release is available here.

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The Next Gen ACO Coalition includes 20 ACOs committed to advancing two-sided risk models. Throughout the COVID-19 pandemic, these ACOs have used their investments in population health to provide care to their communities in new and innovative ways. Read more about our ACO resilience case studies here.

Advanced Alternative Payment Model Thresholds

Advanced Alternative Payment Model Thresholds

Washington D.C. (Dec, 2020) – Next Generation ACO Coalition participants joined 501 practices across the country today calling on Congressional leaders to act to ensure access to strong financial incentives for clinicians participating in two-sided risk models that deliver high quality, coordinated, cost-effective care.

Congress enacted legislation, the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA), establishing an incentive payment for providers who participate in Advanced Alternative Payment Models (APMs). The law included a 5% Medicare bonus intended to accelerate the transformation away from fee-for-service, volume-based reimbursement. This funding helps clinicians continue to build on the success of these models, driving further innovation that benefits patients. To qualify for the bonus, Advanced APMs must achieve certain revenue or patient count thresholds to demonstrate sufficient shifts to risk-bearing models.

In 2021, both the revenue and patient participation thresholds for the advanced APM bonus are scheduled to significantly increase. Currently, to qualify for the 5 percent bonus clinicians must have 50 percent of payments or 35 percent of patients in an advanced APM. In 2021, the thresholds jump to 75 percent of payments or 50 percent of patients. These dramatic increases will cause many clinicians, including those participating in the highest levels of financial risk available in the Medicare program, to lose the opportunity to qualify for a bonus payment.

“If providers cannot count on receiving these bonus payments, due to unrealistic thresholds, fewer providers will be willing to participate in APMs in the future, exactly the opposite of what MACRA’s authors intended when they drafted the threshold tests” the letter states.

Today, 501 practices, including Next Generation accountable care organizations (ACOs), are calling on Leadership in the House and Senate to freeze the MACRA APM thresholds at the 2020 levels for the next two performance years. “This freeze will give us the flexibility and financial security we need to continue to innovate and improve population health for our patients, as well as to continue to drive forward models that create a fiscally health future for the Medicare program” the letter concludes.

The increased threshold is set to take effect January 1, 2021.

The full letter is available here.

CMS Physician Fee Schedule Proposed Rule Comments

CMS Physician Fee Schedule Proposed Rule Comments

Washington D.C. (Oct, 2020) – On October 5, 2020, the Next Gen ACO Coalition submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Proposed Rule. The letter responds to the agency’s proposals, including a proposal to transition Medicare ACOs to a new quality reporting system and performance standards and proposals around the advanced alternative payment model (APM) thresholds to qualify for a five percent incentive payment.

The Coalition calls for CMS to delay implementation of its quality proposals. As ACOs and their communities continue to recover from and respond to COVID-19, sweeping changes to the quality reporting and performance standards would create additional burden. In addition, the Coalition reiterates its call for CMS to freeze the patient count threshold for ACOs in 2021 to ensure that ACOs taking the highest levels of risk available in traditional Medicare qualify for the bonus as intended by Congress.

The full letter is available here.

Members of Congress Urge House Leadership to Stop MACRA APM Threshold Cliff

Members of Congress Urge House Leadership to Stop MACRA APM Threshold Cliff

Washington D.C. (Sept, 2020) – Members of the House of Representatives sent a letter to House Speaker Nancy Pelosi and Minority Leader Kevin McCarthy encouraging the House to take action to ensure that entities participating in value-based care contracts continue to qualify for bonuses intended to reward clinicians that participate in performance-based risk in traditional Medicare.

The Medicare Access and CHIP Reauthorization Act (MACRA) created an incentive payment for entities that take on certain levels of financial risk in traditional Medicare. The statute established certain requirements to qualify for the bonus payments. One such requirement is achieving a threshold related to participation. In 2021, the threshold test jumps dramatically. Now, risk-bearing accountable care organizations (ACOs) and Members of Congress are calling for relief from this cliff. The letter urges House leadership to act to prevent the cliff from going into effect.

The Coalition thanks the Members of Congress for their support in this important effort.

The full letter is available here.

NGACO Model Adjustments for COVID-19

NGACO Model Adjustments for COVID-19

Washington D.C. (June, 2020) – The NGACO Coalition’s Feedback on Model Adjustments for COVID-19 (excerpt)

On behalf of the Next Generation ACO Coalition, we write to thank you for the flexibilities you have implemented, including extending Next Gen for 2021, and request additional modifications to the program to bolster the move to performance-based risk.

Next Gen is currently the most advanced model in the CMS Innovation Center’s performance-based risk portfolio. The model tests higher levels of financial risk, reward, and accountability for patient populations. Since 2016, Next Gen ACOs have been leading the health care system’s transformation from volume to value.

Next Gens have rapidly deployed care coordination and care management services to prevent the spread of COVID-19 and care for patients with chronic conditions who are under stay-home orders. Examples include…

The full feedback document is available here.

CMS Extends Next Gen ACO Model for 2021

CMS Extends Next Gen ACO Model for 2021

Washington D.C. (June, 2020) – Today, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced that the Next Generation ACO model will be extended for an additional year. On behalf of our 21 ACO members and the thousands of patients we serve across the country, the Next Generation ACO Coalition thanks CMS and the Innovation Center team for recognizing the value of this model and strengthening the future of accountable care. This extension ensures that we can continue providing quality, affordable services to our communities.

Next Gen is the most advanced model in the CMS Innovation Center’s performance-based risk portfolio. The model tests higher levels of financial risk, reward, and accountability for patient populations. Since 2016, Next Gen ACOs have been leading the health care system’s transformation from volume to value, a movement that can now continue through 2021.

An extension of the model does not mean that our work is done. In the short term, we will continue to deploy care coordination and care management services to prevent the spread of COVID-19 and care for patients with chronic conditions who are under stay-home orders. As the pandemic recedes and states return to full operations, we remain committed to managing population health and accelerating the movement to performance-based risk. We thank CMS for partnering with us to advance these goals.

Please see the CMS flexibilities blog post and model flexibilities table for additional information on the extension.

NGACO Coalition asks CMS to freeze the MACRA patient count threshold for 2021

NGACO Coalition Asks CMS to Freeze MACRA Patient Count Threshold in Response to COVID-19 Outbreak

Washington D.C. (April, 2020) – The NGACO Coalition, which represents 20 of the Next Generation ACOs, is requesting that the Centers for Medicare and Medicaid Services use its regulatory authority to freeze the MACRA patient count threshold for Advanced APM bonus eligibility at current levels. The attached document outlines the challenges presented by planned threshold increases, especially during a time when Next Generation ACOs are marshaling all possible resources to combat COVID-19.

The full letter is available here.

NGACO Coalition Feedback on Direct Contracting Model

NGACO Coalition Feedback on Direct Contracting Model

WASHINGTON, D.C. (Jan, 2020) – The NGACO Coalition’s Feedback on Direct Contracting Model (excerpt)

CMMI Should Reduce the Financial Exposure in the Direct Contracting (DC) Model

Issue: The current financial model includes a 2-5% discount for global model participants; a 2% retention withhold for early termination; a 5% quality withhold; and a leakage withhold. CMMI limits the maximum upward and downward adjustment that can result from incorporating regional expenditures into the benchmark, with an upward limit of 5% and a downward limit of 2%. CMMI has not yet released the risk adjustment methodology for DC. The total impact of these withholds and discounts represents significant risk exposure for participants.

NGACO Coalition Recommendations:

  • CMMI should reduce or waive some of the model’s withholds and discounts:
    • CMMI should waive the 2% retention withhold for entities with experience with two-sided risk as they have made significant investments in the infrastructure to manage risk and have demonstrated their commitment to do so.
    • CMMI should reduce the discount percentage in the global model.
    • CMMI should increase the cap on the regional component of the benchmark from 5% to 10% to align with Next Gen. The floor should remain at 2%.
  • CMMI should ensure that the DC risk adjustment methodology aligns to the risk adjustment methodology for Medicare Advantage (MA) (i.e., uncapped).
  • In the global model total care capitation track, DCEs should be able to negotiate their capitation with CMS, including the option for a seasonality adjustment to reflect on-the-ground factors specific to the DCE’s patient population. DCEs should have the option for a higher upfront payment and reconciliation, similar to the approach offered for primary care capitation.
  • CMMI should allow Standard DCEs to nest High Needs DCEs. Removing the most complex subset of the population and those providers creates substantial financial risk and results in an unfair playing field for Standard DCEs as compared to High Needs DCEs.

The full feedback document, including other issues and recommendations, is available here.

CMS Releases New ACO Case Studies

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.