CMS Announces Next Generation ACO Models

In an announcement January 11, 2016, the Centers for Medicare & Medicaid Services (CMS) announced the addition of 121 new participants in Medicare Accountable Care Organization (ACO) initiatives designed to improve care and lower costs for patients representing participation in 49 states plus the District of Columbia.

Sylvia M. Burwell, Health and Human Services secretary, revealed the launch of the new ACO initiatives, which in addition to being paid for positive patient outcomes will also receive penalties for negative ones.

The Next Generation ACO Model from the CMS Innovation Center is for ACOs experienced in coordinating patient care. It allows participating ACOs to assume higher levels of financial risk—up to 100%—and reward than are available under current models. The goal is to determine if strong financial incentives, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for patient care.

Participating ACOs will receive their budgets prospectively, rather than retrospectively, in order to plan and manage care around financial targets from the outset. The ACOs will also be able to select from flexible payment options, such as infrastructure payments that support ACO investments in care.

This model will be evaluated on its ability to deliver better care for individuals, better health for populations and lower growth in expenditures. CMS will publicly report the performance of the Next Generation Pioneer ACOs on quality metrics, including patient experience ratings, on its website.

Questions regarding the Next Generation ACO Model can be directed to NextGenerationACOModel@cms.hhs.gov.

Thirty-nine Shared Savings Program ACOs will also participate in the ACO Investment Model (AIM). This model, which has a total of 41 participants, will provide prepaid shared savings to encourage new ACOs to form in rural and underserved areas and to encourage current Shared Savings Program ACOs to transition to performance-based risk arrangement.

With new participants in the Shared Savings Program (SSP), the Next Generation ACO Model, Pioneer ACO Model, and the Comprehensive ESRD Care Model, there will now be:

• Nearly 8.9 million beneficiaries served;

• A total of 477 ACOs across SSP, Pioneer ACO Model, Next Generation ACO Model, and Comprehensive ESRD Care Model;

• 64 of the ACOs are in a risk-bearing track, including SSP, Pioneer ACO Model, Next Generation ACO Model and Comprehensive ESRD Care Model.