Each of the ACO organizations that participates in the Next Generation Program has significant experience with accountable care initiatives such as the Medicare Shared savings Program and the Pioneer ACO Program. 28 New organizations have joined the Next Generation ACO model for 2018. These numbers bode very well for the future of the Next Generation ACO Program. Historically ACO's have been organizations that are primary care-centric, but CMS does have a Dialysis Model for ACO's and that particular model has also demonstrated significant savings. In fact the disease specific ACO resulted in over $51 million dollars in savings across 13 organizations. Every participating organization realized savings ranging from 1.57% to 12.55%.
The results of the Next Generation ACO and the End Stage Renal Disease specific ACO demonstrate that these programs are effective in achieving cost reductions for Medicare. The program are working and more organizations are buying into the model. For 2018 it appears that there will be 43 Next Generation ACO's and 1 Specialty Specific ACO. This does not represent a majority of the care providers in the country at this time, but as long as the organizations are able to participate in the program in a cost effective manner and achieve shared savings the program is likely to grow is size and scope.
There are a number of potential paths forward for specialists. The Next Generation ACO's are primary care specific but will be looking to contract with specialists that can demonstrate cost effective care. Cost effective care is best demonstrated by reporting on quality measures. When selecting which quality measures to report, it is important to select measures that are specific to the specialist. Selecting measures that are primary care-centric is less likely to make a specialist attractive to an ACO in that the ACO is probably already ensuring quality and cost effective treatment for the quality measures that are in the realm of the primary care provider. Demonstrating quality and cost effective care in the areas where the specialist is practicing can be much more effective in marketing your practice to an ACO and negotiating better contracts.
When thinking about which quality measures to report on the following items need to be taken into consideration:
What percentage of my patient population is eligible for reporting on this measure. If you can report a quality measure that reflects quality for 90% of your patients is much more compelling than a quality measure that only reflects 10% of your practice. Demonstrating quality and cost effective care for a majority of patients that you care for will put you in a better negotiating position. Therefore you want to adjust your workflows to allow you to demonstrate high scores for the measures that best represent your scope of practice. ACO's and Insurance companies will look to be that granular when evaluating your practice. The key to protecting the financial health of your practice is to be prepared to participate in the payment paradigms of tomorrow to ensure that you have access to patients and that the patients have access to your office with their insurance plans.
Details on the End Stage Renal Disease ACO can be found on the Medicare Innovation Center Web Site at https://innovation.cms.gov/initiatives/comprehensive-esrd-care/
Details on the performance of Next Generation ACO's can be found at the Data.CMS.gov web site at https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/...