CMS Unveils Three New ACO Initiatives

The Centers for Medicare & Medicaid Services (CMS) announced May 17 three new initiatives the agency says will give physicians, hospitals, and other health care providers new options and incentives to participate in Accountable Care Organizations (ACOs).

Pioneer ACO Model

The Center for Medicare and Medicaid Innovation (Innovation Center) is requesting applications for organizations to participate in the new Pioneer ACO Model, which the agency says will save Medicare up to $430 million over three years by better coordinating patient care.

This model—expected to begin this summer and run through December 2016—is designed for advanced organizations already coordinating care for a significant portion of patients under financial risk-sharing contracts and positioned to transform both their care and financial models from fee-for-service (FFS) to a three-part aim: better health, better health care, and lower per-capita costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).

Pioneer ACO Model goals include:

  • Test a more rapid transition for providers from FFS payments to payment for coordination and outcomes.
  • Promote a diversity of successful ACOs, including physician-led ACOs.

The Innovation Center says it expects to partner with approximately 30 organizations in the model, with a minimum of 15,000 Medicare beneficiaries each (5,000 for rural ACOs).

Organizations interested in applying to the Pioneer ACO Model must submit a letter of intent on or before June 10. Applications must be received on or before July 18. The Pioneer ACO Request for Application, the Letter of Intent form and the Application form may be accessed online. The Innovation Center will hold an Open Door Forum to review the Pioneer ACO Model Request for Application on June 7.

Advance Payment ACO Model

The Innovation Center is also seeking comment on the idea of an Advance Payment ACO Model that would provide additional up-front funding to providers to support the formation of new ACOs.

More information about the Advance Payment ACO Model can be found online. The Innovation Center is accepting comments on the Advance Payment ACO Model until June 17.

Accelerate Development Sessions

The Innovation Center also has arranged for free three-day Accelerated Development Sessions (ADS) for provider groups interested in learning more about how to coordinate patient care through ACOs. Through ADSs, the Innovation Center says it will test whether intensive shared learning activities expand and improve the capabilities of provider organizations to coordinate care of the Medicare population more effectively.

There are four ADSs scheduled for 2011. The first session is scheduled for June 20-22 in Minneapolis, Minn. Individuals wishing to attend the June ADS in person may register online. Note that these sessions are free, but transportation, room, and board are not.

More on ACOs

The Affordable Care Act requires CMS to examine new ways to reduce spending in Medicare, Medicaid, and CHIP while improving the quality of care and health outcomes for beneficiaries. As a result, CMS issued a proposed rule to implement the Medicare Shared Savings Program in March 2011 and is accepting comments from providers and the public until June 6, 2012.

The Pioneer ACO Model and the Medicare Shared Savings Program are two distinct programs. Providers may participate in either program, but not both. These newest initiatives are intended to complement the Medicare Shared Savings Program by providing additional options for ACOs—a concept not widely accepted as yet. In fact, 10 physician groups that participated in an ACO demonstration project offering similarly structured incentive payments recently told CMS in a joint letter that Medicare’s proposed ACOs rules are too risky.

And, according to AHANews.com, seven Republican members of the Senate Finance Committee asked CMS in a letter to withdraw its proposed regulation for the Medicare accountable care organization program, stating they have “serious concerns” with the rule as written.

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