Dive Brief:
- Although CMS' ACO models during the past five years have in some ways missed the mark, ACO operators and policy watchers shouldn't dismiss the latest Next Gen ACO model, suggested a new Health Affairs blog by Chris Dawe, Nico Lewine, and Mike Miesen. Dawe was involved in the early development of the Next Gen ACO model.
- They say while response to the model has been tepid so far, savvier organizations are increasingly showing interest in the Next Gen model’s progressive new terms.
- The authors warn ACO operators that bypass the Next Gen model this spring could regret being locked out for the "foreseeable future," suggesting it's unlikely a similar model will be available again before 2020.
Dive Insight:
The authors say CMS' early ACO models had a variety of flaws that impeded their effectiveness, pointing in particular to “Track 1” of the Medicare Shared Savings Program (MSSP), noting it accounted for 330 of all the 353 Medicare ACOs in 2014. The flaws included patients having little incentive to seek care within such a network and that ACOs only share share at most 50% of generated savings.
They argue, however, CMS heard and addressed the complaints about early models by incorporating extensive feedback from health systems.
"Next Gen is therefore a program that health systems have directly asked for," the authors wrote, while conceding the model has room for more improvement, specifically noting, "Next Gen ACOs should have access to the full toolkit of benefit- and network-design strategies found in Medicare Advantage and other provider-led offerings. But the [CMS Innovation Center] leadership has pledged to pursue additional features that could take effect in the later years of the Next Gen model, and will continue the virtuous cycle of improvements."
The authors also noted Next Gen ACO participants need to deal with the hurdles of risk exposure and a closing decision window through financial and operational strategies.
"The Next Generation ACO Model may come to be seen as the cornerstone of CMS’s efforts to shift the majority of its payments towards value-based care," the authors suggested. "For health systems it represents an opportunity to secure provider-friendly deal terms and help define their own destiny in a rapidly-evolving Medicare payment landscape."
ACOs interested in participating need to submit a non-binding Letter of Intent by May 2 and a full application by May 25.