http://www.beckershospitalreview.com/lists/110-acos-to-know-2017.html
In its sixth edition, Becker’s Healthcare is pleased to highlight a variety of Medicare and commercial payer accountable care organizations led by hospitals, health systems, physician groups and other organizations.
Leavitt Partners, a Salt Lake City-based healthcare consulting firm, reports 934 active public and private ACOs in the United States during the first quarter of 2017 covering 2.2 million lives. Over the past year, 138 new ACOs began operation and 46 dropped their accountable care contracts, leading to an 11 percent growth year-over-year, according to Health Affairs.
Several ACOs represented on this list participate in the Medicare Shared Savings Program. Tracks 1 and 2 have limited provider risk; participants can benefit from shared savings but aren’t at risk for loss. MSSP Track 3, added in 2016, creates shared savings opportunities with greater risk. Track 3 ACO providers can share up to 25 percent of savings, but are at risk for loss. The most recently reported data for MSSP ACOs is the 2015 performance year.
CMS launched the Next Generation ACO Model in 2016, requiring providers to shoulder greater financial risk with the potential of earning more shared savings. The Next Generation ACOs qualify as advanced alternative payment models under the Medicare Access and CHIP Reauthorization Act’s Quality Payment Program in the 2017 reporting year. There are currently 45 participants in the Next Generation ACO Model.
These governmental contracts are in addition to commercial ACO arrangements, which at 715 in number, represent the plurality of all contracts, according to Health Affairs. Commercial ACOs tend to cover more lives than their Medicare counterparts.
Becker’s included ACOs on this list based on several factors, such as cost performance, participation in CMS ACO models and participation in innovative commercial agreements. ACOs are presented in alphabetical order. ACOs with multiple contracts are listed by the health system or provider group name.
ACOs in Track 1 of the Medicare Shared Savings Program are losing out on millions of dollars in additional net payments from CMS by not taking on more risk and missing out on the Quality Payment Program’s 5 percent lump sum bonus payment for ACOs in Track 2 and 3, according to an analysis from Avalere.
The analysis simulates how much Track 1 ACOs would earn if they were enrolled in Track 2 — based on 2015 performance — and the QPP was in place. Track 1 ACOs do not bear downside financial risk, and therefore share in a smaller portion of savings than their Track 2 and 3 counterparts. However, if these ACOs had taken on more risk in 2015, they would have earned $178 million more in shared savings, according to the analysis. And if the Track 1 ACOs took on downside risk, they would qualify as an Advanced Alternative Payment Model under the Medicare Access and CHIP Reauthorization Act’s QPP. These models have the opportunity to earn a bonus up to 5 percent on Medicare Part B expenditures — and based on 2015 performance, those ACOs would be leaving $1.1 billion in AAPM bonus payments on the table by not bearing the downside risk necessary to qualify, according to the report.
“The CMS’ new value-based payment incentives really tip the scales for doctors to assume greater financial risk,” Josh Seidman, PhD, senior vice president at Avalere, said in a statement. “For those physicians who were dipping their toes in the water with low-risk ACO models, the incentives now make it advantageous for a majority of them to move more aggressively into greater accountability for population health.”
Of course, some of the ACOs would have also generated net losses. The analysis indicates some of the ACOs in the simulation would have had to pay back CMS for spending above the benchmark. These shared losses would have totaled $437 million. Benefits and losses taken together, if all Track 1 ACOs joined Track 2 of the MSSP and performed as well as they did in 2015, they would earn additional net payments of $886 million, according to the analysis.
However, the majority of ACOs would still benefit by joining Track 2. Avalere found 79 percent, or 307 of the Track 1 ACOs, would have financially benefitted, compared to 21 percent, or 82, that would not.
This year 486 ACOs are participating in Track 1, accounting for most of the MSSP program. Track 2 counts just six participants and Track 3 has 36 ACOs.
Just as the fate of the Affordable Care Act is up in the air, so is the future of accountable care organizations, which were established under the healthcare reform law to improve care and reduce costs.
But one leading health policy expert predicted that even if Republican lawmakers come up with a plan to repeal and replace the healthcare reform law, ACOs will survive. They will just need to adapt to the new regulatory landscape.
“ACOs are here to stay,” wrote Paul Keckley, Ph.D., managing editor of The Keckley Report, in a post for Hospitals & Health Networks. “How they fit into a medical group or health system’s contracting and population health strategies will change as regulations like MACRA kick in and as employers, insurers, Medicare and Medicaid assess their value.”
More than 850 ACOs currently provide care to more than 28 million patients across the country. This year 570 ACOs will participate in Centers for Medicare & Medicaid Services models, including the Shared Savings Program (MSSP), Next Generation ACO Model and The Comprehensive ESRD Care Model.
Two recent studies showed evidence that ACOs do lead to quality improvements and cost reductions, but those benefits grow over time. The problem is that Tom Price, the new head of the Department of Health & Human Services, doesn’t support some value-based care initiatives, such as Medicare’s mandatory bundled payment initiatives for hip and knee replacements.
But Keckley predicted physician-led ACOs that follow practices to standardize care and incentives for clinicians linked to cost savings will survive. However, in order to survive the organizations must focus on primary care driven care coordination, he said. “From these primary care centric models, virtual ACOs that incorporate rural health and teleconnectivity, and clinical models that include social determinants of health in assessing risks and care coordination tactics will evolve,” he wrote.
He also predicted that CMS will change quality measures and simplify reporting requirements under MSSP ACOs. And if Congress does move to Medicaid block grants, he expects Medicaid ACOs will be a growth opportunity.
https://www.aledade.com/new-journal-article-a-report-from-the-field/
The trillion dollar shift in healthcare payment “from volume to value” is well underway with both public and private payers and purchasers pushing provider organizations to participate in outcome-based risk contracts, stepping up from pay-for-performance and medical home models to a variety of accountable care and bundled payment programs.
But what are we to take away from the mixed results of these programs — from the lack of savings in the Comprehensive Primary Care demonstration, to the dropouts from the Pioneer program, the recently released underwhelming results from the first year of the Bundled Payment for Care Improvement Initiative, or the 2015 results from the Medicare Shared Savings Program?
One approach would be for partisans for each of these approaches to search for positive nuggets in the results from their preferred program, while heaping scorn on the other “competing” reforms.
Another would be to retreat altogether from the aspirations of achieving better care at lower cost, towards either resignation towards ever-escalating health care costs or more likely to (altogether regretful!) rationing of access to good healthcare for the most vulnerable in our society.
A third path would be to acknowledge that there is no magic bullet for “transforming healthcare” overnight, and that the work of redesigning our delivery systems to meet the expectations of the outcome-based payment models will be slow, hard, and uneven. We would accept that there are likely multiple payment reforms that will need to be implemented alongside each other, targeting different healthcare markets and different participants. (Capitated payments for truly integrated delivery networks. Mandatory bundled payments for proceduralists and hospitals. Accountable care for independent physician networks). And each model will need to be iterated and tweaked and incrementally improved.
That is what I choose to believe.
We are publishing today in the new issue of the American Journal of Managed Care, “A Report From the Field,” the detailed description of what our two ACO “freshman” accomplished in 2015, and openly discussing the challenges we faced, what we are doing differently now, and some policy changes that can put more wind to the backs of those in these trenches.
Here are a few of the key findings:
Conclusions:
We have learned that, given the right support and incentives, independent primary care practices can embrace population health and practice redesign. These efforts can begin to bear fruit in improved patient access, quality of care, and appropriate utilization in the short term. We strongly believe that the benefits of the program to patients and the taxpayer are not limited to those ACOs that received shared savings distributions. However, lack of recognition of these contributions may stifle continued innovation and physician engagement with alternative payment models. Aledade is committed to navigating these challenges and we are committed to sharing our learning so that more independent physician-led ACOs can succeed in their mission to profitably deliver better care at lower cost. We also hope that policy makers and commercial payers continue to work to remove the unintended policy headwinds ACOs must presently overcome. – See more at: http://www.ajmc.com/journals/issue/2016/2016-vol22-n9/the-opportunities-and-challenges-of-the-mssp-aco-program-a-report-from-the-field/P-5#sthash.3V1BtAtZ.dpuf
HENRY KOTULA 