Types of Medicare ACO Models and Programs
In the realm of healthcare, various models and programs exist under Medicare to encourage coordinated care and improve quality outcomes. From the Medicare Shared Savings Program to the ACO Investment Model and Advance Payment ACO Model, each initiative aims to support different types of accountable care organizations. Whether it's through one-sided risk/reward tracks or two-sided risk/reward options, these models offer opportunities for providers to enhance patient care while navigating financial incentives. Furthermore, the Next Generation ACO Model provides predictability and tools for improved patient engagement, all in the pursuit of better health outcomes for Medicare beneficiaries.
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Presentation Transcript
Medicare Shared Savings Program: Basic Track Fee for service beneficiaries Designed for less experienced ACOs BASIC Track Levels A & B: One-sided risk/reward up to 40% based on quality performance Level C: Two-sided risk/ reward up to 50% based on quality performance Level D: Two-sided risk/reward up to 50% based on quality performance Level E: Two-sided risk/reward up to 50% based on quality performance
Medicare Shared Savings Program: Enhanced Track Two-sided risk/reward up to 75% based on quality performance Highest level of risk/ reward under the Shared Savings Program To learn more: https://www.cms.gov/Medicare/Medicare-Fee-for- Service-Payment/sharedsavingsprogram/Downloads/ssp-aco- participation-options.pdf
ACO Investment Model Designed for organizations participating as ACOs in the Shared Savings Program Tests the use of the pre-paid shared savings to encourage new ACOs to form in rural and underserved areas Encourages ACOs to transition to plans with greater financial risk ACOs will receive three types of payments: upfront/variable payment, upfront/fixed payment and a monthly payment of varying amounts depending on the size of the ACO To learn more: https://innovation.cms.gov/initiatives/ACO-Investment- Model/
Advance Payment ACO Model Designed for physician-based and rural providers who have come together voluntarily for coordinated high quality care to the Medicare patients they serve Helps smaller ACOs with less access to participate in the Shared Savings Program ACOs will receive three types of payments: upfront/variable payment, upfront/fixed payment and a monthly payment of varying amounts depending on the size of the ACO To learn more: https://innovation.cms.gov/initiatives/Advance- Payment-ACO-Model
Next Generation ACO Model Designed to set predictable financial targets and enable providers and beneficiaries greater opportunities to coordinate care Allows provider groups to assume higher levels of financial risk and reward Goal is to test whether strong financial incentives for ACOs and tools to support patient engagement can improve health outcomes for fee for service beneficiaries To learn more: https://innovation.cms.gov/initiatives/next-generation- aco-model/
Pioneer ACO Model Designed for health care organizations and providers that were already experienced in coordinating care for patients across different care settings Allows provider groups to move rapidly from shared savings payment models to population-based payment models on tracks consistent with the Medicare Shared Savings Program More flexible than other models in order to accommodate the organizational and market conditions To learn more: https://innovation.cms.gov/initiatives/Pioneer-ACO- Model/
Tips for Successful ACO Participation Understand your attributed population Understand the quality measures Understand your claims data Educate your patients Engage in future planning
