CMS Releases Three Initiatives to Expand Medicare ACO Participation

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To reach its goal of reaching 100% of people receiving traditional care in an accountable relationship within seven years, the Centers for Medicare and Medicaid Services announced three initiatives under the Medicare General Savings Program and the ACO REACH and Kidney Care Choices models.

More than 700,000 healthcare providers and organizations will take part in at least one of the three initiatives this year, according to CMS. These programs are expected to expand to provide assistance to more than 13.2 million people on Medicare.

WHY IS IT IMPORTANT

In 2023, the number of reporting medical organizations serving Medicare patients will increase slightly in 2023, according to CMS data.

While the Shared Savings Program saw a reduction in the number of ACOs and designated beneficiaries for 2023, the policies approved in the final rule of the Medicare Payment Schedule for 2023 are expected to drive enrollment growth for 2024 and beyond when many of the new policies are due to take effect, CMS said in a statement.

Participation in the Medicare General Savings Program peaked in 2018 with 561 ACOs, but fell as the CMS issued rules that forced ACOs to take financial risks more quickly, according to the National Association of ACOs.

CMS completed several changes to the MSSP last year that will encourage vendors to join ACO, according to NAACOS. This includes providing upfront investment money that pays off through general savings, a slower path to financial risk, and setting more realistic targeted financial spending policies.

Also last year, the CMS Innovation Center made numerous updates to the ACO Realizing Equity, Access, and Community Health (REACH) model, which improves provider management, places more emphasis on health equity, and provides additional oversight and patient protection.

There are currently 456 ACOs in the Medicare General Savings Program, the country’s dominant value-based payment program, and 132 members in the ACO REACH model.

This year, 67% of ACOs in the General Savings Program are subject to two-sided risk, and 33% are subject to one-sided risk. About 704,000 doctors and other non-physicians and more than 1,450 hospitals are members of the ACO, according to NAACOS. NAACOS said it supports CMS’s goal of having all traditional Medicare beneficiaries by 2030 in a care relationship with a provider who is responsible for their quality and overall cost of care.

American’s Physician Groups includes numerous member organizations participating in the 2023 ACO REACH Model. APG President and CEO Susan Denzer said all participants in the model achieved 100% compliance with quality scores and continue to show quality improvements over the rest of Medicare.

Dentzer said: “The new CMS data shows that in the 12-month period ending June 2022, model participants achieved unscheduled hospitalization rates for patients with multiple chronic conditions that were statistically significantly lower than all other Medicare programs. the traditional fee-for-service program, the Medicare General Savings Program, and the next generation ACO program.”

BIG TREND

ACOs are groups of doctors, hospitals, and other health care providers that work together to provide coordinated, high-quality care for their Medicare patients. The goal is to reduce fragmentation between providers to avoid unnecessary duplication of services and prevent medical errors.

In February, CMS reworked the health equity-focused ACO REACH’s controversial global and professional direct contracting model.

Opponents of direct contracting believed that this would lead to the privatization of Medicare. Physicians in the National Health Program also spoke out against ACO REACH, calling it “direct contracting in disguise.”

CMS stated that ACO REACH is Medicare’s first accountable care model that directly addresses issues related to health equity and affordability. Members are financially responsible for overall health and care costs. This policy is expected to drive growth in participation, especially in rural and underserved areas, promote equity and alignment of accountable care initiatives, and increase the number of beneficiaries designated for ACOs participating in the program to four million over the next few years. years.

The ACO REACH model includes control adjustments for payment offsets to improve care support for underserved and expanded Medicare benefits, including home care.

For 2023, the ACO REACH model includes 132 ACOs with 131,772 health care providers and organizations providing care to approximately 2.1 million beneficiaries. In 2023, 824 federally qualified health centers, rural health centers and critical access hospitals are participating, more than double their number in 2022.

The Kidney Care Choice model aims to coordinate the care of Medicare recipients with stage 4 and 5 chronic kidney disease and end stage renal disease. In addition to coordinating care, the KCC model aims to delay the start of dialysis and increase access to kidney transplants.

For 2023, the model will include 130 KCC objects. More than 8,398 health care providers and organizations and 249,983 beneficiaries will participate in the KCC model in 2023. This means an 87% increase in the number of providers and organizations and a 62% increase in the number of beneficiaries compared to 2022. The KCC model cohort extends the geographic coverage of the model to new areas, including North Dakota and South Dakota.

IN RECORDING

CMS Administrator Chiquita Brooks-LaSure said, “Health care providers who come together in Accountable Care Organizations provide high-quality, equitable care for people with Medicare while improving the sustainability of the Medicare program.”

Cliff Gauss, President and CEO of NAACOS, said: “We expect 2023 to be a turning point for ACOs, with participation growth really accelerating in 2024 thanks to CMS leadership. Interest in high-risk models such as ACO REACH should be a signal that CMS needs to include more high-risk options with many of the features of REACH into the shared savings program.”

America’s Physician Group President and CEO Susan Dentzer said, “2023 will be a pivotal year for this model as, for the first time, participants are held accountable for implementing health equity plans to reduce racial, ethnic and other disparities in care. “

Twitter: @SusanJMorse
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