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CMS announces 15 new participants for CMMI’s Advance Payment ACO Model

Posted on July 19, 2012 | No Comments

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The Centers for Medicare & Medicaid Services (CMS) announced that 15 new accountable care organizations (ACOs) were selected to participate under the Center for Medicare and Medicaid Innovation’s (CMMI’s) Advance Payment ACO Model. This brings the total number of advance payment ACOs to 20. The initiative is designed for smaller physician practices and rural practitioners who would benefit from additional start-up resources while participating in the Medicare Shared Savings Program (MSSP). Each participating ACO will receive advance payments to help establish care coordination for beneficiaries.

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In a field report published yesterday, the Commonwealth Fund discusses the progress made by accountable care organizations (ACOs) in improving health care quality and efficiency. ACOs, established by the Affordable Care Act (ACA) as a Medicare delivery system option, are designed to systematically improve health care delivery and mitigate cost increases by forming contractual relationships between physicians and payers. This report details the successes and challenges experienced by seven hospital-physician groups that are considered early-adapters of the ACO model. These entities are involved, or will soon be involved, in risk-sharing arrangements with public and private payers. Representatives from the featured ACOs discuss their strategies for integrating clinicians, managing practices, designing incentives, and sharing rewards. The goal of this report is to educate providers in methods that promote partnership and success in ACOs.
A new report released by the Government Accountability Office (GAO) found that the new Innovation Center needs to work harder to avoid duplicating efforts of the rest of the Centers for Medicare & Medicaid Services (CMS). Senators Tom Coburn, Orrin Hatch and Mike Enzi  asked GAO to look at what the Innovation Center has accomplished over the past two years and to determine whether it’s sufficiently executing quality measures. According to the GAO report, both the Innovation Center and CMS are conducting experiments regarding Medicare and Medicaid payment models and methods for reducing hospital readmissions. CMS officials defended the similar projects, arguing that they are meant to complement each other. GAO warned that the agency still needs to put a complete process in place for reviewing and eliminating any areas of repetitive work.
Health care delivery systems that reward providers for coordinating and improving care hold promise for slowing the rise of health care costs for the most vulnerable patients, according to a new study by Dartmouth researchers published in the Journal of the American Medical Association (JAMA). To learn how such models, such as accountable care organizations (ACOs), are likely to perform for patients with severe health conditions, researchers from the Dartmouth Atlas Project and The Dartmouth Institute for Health Policy & Clinical Practice studied the Medicare’s Physician Group Practice Demonstration (PGPD). The study focused on the care provided to patients covered by both Medicare and Medicaid, also known as “dual eligible” patients. The nation’s 9 million dual eligibles comprise 20 percent of the Medicare population but account for 31 percent of its spending, and comprise 15 percent of the Medicaid population but 39 percent of its spending. The study highlights the potential benefits of the ACO model for dual eligible patients. Dartmouth’s analysis of Medicare spending for PGPD patients found that the participating health systems achieved their savings largely by reducing hospital stays. An accompanying analysis of quality indicators also showed that quality of care did not decline.
Accountable care organizations (ACOs) are groups of providers that agree to take collective responsibility for delivering and coordinating care for a designated population. A report recently released by the Commonwealth Fund shares the perspectives of hospitals and health systems taking part in the Premier health care alliance’s accountable care implementation collaborative. Lessons emerging from the collaborative relate to the need for ACOs to have six core structural components: 1) the viability of different organizational models; 2) the importance of people-centered care in all interactions; 3) the need to align business with value-based payments and design incentives to encourage providers to collaborate; 4) the use of financial modeling to assess the impacts of the accountable care model; 5) the need for investments in information technology to enable care coordination; and 6) the importance of performance assessment across a broad range of clinical quality, efficiency, and satisfaction measures.
A recent analysis, funded by the RCHN Community Health Foundation and authored by researchers from the Geiger Gibson Program in Community Health Policy at the George Washington University, examines Medicare Accountable Care Organizations (ACOs) and their effect on community health center patients. The analysis finds that rules requiring ACO services to be provided by a physician only, may effectively exclude from ACO participation certain underserved populations who use non-physician providers for their primary care. Sara Rosenbaum, lead author of the study, is a frequent contributor to HealthReformGPS.
A key provision of the Affordable Care Act (ACA) is the establishment of the Medicare Shared Savings Program, which provides incentives for improved quality and efficiency in a new category of provider--the accountable care organization (ACO). The ACO program is slated to begin in January 2012 and will reward groups of providers who agree to collaborate and offer more accountable, effective, and efficient care with a share of the savings that they achieve. The Commonwealth Fund Commission on a High Performance Health System's report "High Performance Accountable Care: Building on Success and Learning from Experience," provides recommendations for ensuring effective, efficient implementation and growth of the ACOs. Specifically, this report 1) sets forth the rationale for creating ACOs; 2) describes several promising types of ACO models that should be considered and evaluated as part of an effort to facilitate adaptability and spread of accountability for quality and cost; and 3) concludes with a set of Commission recommendations on what ought to be expected from ACOs and how to ensure their successful implementation and spread.
The U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that health care providers have formed 106 new Accountable Care Organizations (ACOs) in Medicare, covering as many as 4 million Medicare beneficiaries. The new ACOs include a practices from 47 states in total, including the Billings Clinic in Montana; Cedars-Sinai Accountable Care in Louisiana; the Marshfield Clinic in Wisconsin; Geisinger Health System in New York and Pennsylvania; and UCLA Health System. About half of all ACOs now are physician-led groups serving fewer than 10,000 beneficiaries, and 20 percent serve rural or low-income areas. Since passage of the Affordable Care Act, more than 250 Accountable Care Organizations have been established. ACOs share with Medicare any savings generated from lowering the growth in health care costs, while meeting standards for quality of care. ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely. The Centers for Medicare & Medicaid Services (CMS) has established 33 quality measures on care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. Federal savings from this initiative are estimated to be up to $940 million over four years.
Today, the U.S. Department of Health and Human Service (HHS) named 32 health care organizations that will participate in the Pioneer Accountable Care Organization Model. The goal of the new ACO Model is to encourage providers, hospitals, specialists, and caregivers to provide more coordinated care, which could save $1.1 billion over a five year period, HHS projects. The Centers for Medicare & Medicaid Services (CMS) Innovation Center is spearheading this initiative and will reward groups that have formed ACOs based on improvements in health of their Medicare patients and their ability to lower health care costs. Under the Pioneer ACO Model, the 32 selected health care organizations will test the effectiveness of several innovative payment models. The goal of the Pioneer ACO model is to provide better care for beneficiaries, improved coordination with private payers, a reduction Medicare cost growth, and rewards for health care providers that deliver high-quality care. The 32 selected Pioneer ACOs represent urban and rural organizations from various geographic regions of the country, covering 18 states and 860,000 Medicare beneficiaries.
The Centers for Medicare and Medicaid Services (CMS) released the much anticipated Accountable Care Organization (ACO) final rule, implementing section 3022 of the Affordable Care Act (ACA), which contains provisions relating to Medicare payments to providers of services and suppliers participating in ACOs under the Medicare Shared Savings Program. The rule on Medicare ACOs relaxes eligibility requirements for doctors and hospitals to participate by halving the number of performance measurements (65 to 33), removing the electronic medical records (EMR) requirement, and eliminating some financial risks. CMS also extended the deadline for ACO applications through 2012. As enticement to rural doctors and physician-owned practices, CMS said it would dedicate $170 million to said providers to start ACOs. Regulators estimate that between 50 and 270 ACOs will be established in the next 3 years, which will affect the care of 4% of Medicare beneficiaries. Multiple federal agencies also released rules and guidance on fraud & abuse and antitrust issues related to ACOs. The HHS Office of Inspector General (OIG) issued an interim final rule (IFR) on the waiver of certain fraud and abuse provisions and the Department of Justice (DOJ) issued a statement on health care antitrust enforcement policies. To read more about ACOs, click here. For the ACO final rule fact sheet, click here.
While a primary aim of the Affordable Care Act (ACA) was to increase access to affordable health insurance coverage, a critical, although less publicized, component of the law is a series of provisions designed to improve health care quality and efficiency and to advance the concept of “value-based purchasing.” The Agency for Health Care Research and Quality (AHRQ) defines the concept of value-based purchasing as holding “providers of health care accountable for both the cost and quality of care.” AHRQ notes that “value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. This strategy can be contrasted with more limited efforts to negotiate price discounts, which reduce costs but do little to ensure that quality of care is improved.”