Accountable Care Organizations: One Option for Innovation

The highly anticipated Oct. 20 Centers for Medicare and Medicaid Services (CMS) final ruling on the Shared Savings Program spurred a vigorous discussion among physicians, hospitals, and administrators regarding the strategic benefits of joining an accountable-care organization (ACO).

Many question whether or not the financial return justifies the effort and investment. While there is no easy answer to this question, it is important to note that the Shared Savings Program represents a unique opportunity for enhancing collaborative efforts among stakeholders in the health delivery system.

The Shared Savings Program is one of many innovative programs the CMS is investigating through the Center for Medicare and Medicaid Innovation Center (CMMI). If participation in the Shared Savings Program isn’t right for your practice but you have an interest in getting involved, other options exist, such as the CMMI programs that follow:

ACO Advanced Payment Model. This program allows eligible organizations to receive an advance on the shared savings they expect to earn in order to help defray the investment necessary to engage in an ACO model.

Pioneer ACO Model. With this program, providers who are already experienced with coordinated-care delivery models can test new and innovative payment models.

Bundled Payments for Care Improvement. This program is for providers who would like to engage in one of four models, three that involve a retrospective bundled payment arrangement and one that pays prospectively.

Comprehensive Primary Care Initiative. This initiative focuses on breaking through the ’historical impasse,’ but invites payers to partner with Medicare to invest in primary care in predetermined regions of the country.

Federally Qualified Health Center Advanced Primary Care Practice Demonstration. This demonstration project seeks to test the patient-centered medical home as a model for improving quality of care, promoting better health, and lowering costs.

Health Care Innovation Challenge. Medicare is looking to award up to $1 billion to innovative projects across the country that test creative models of delivering high-quality, low-cost health care services.

Innovation Advisors Program. This program seeks to create
a network of experts trained, supported, and charged by
CMS to improve the health care delivery system.

Partnership for Patients. This initiative works to engage providers in improving the quality of care available to CMS beneficiaries with the dual goal of preventing patients from getting injured or sicker and helping them heal without complication.

State Demonstrations to Integrate Care for Dual Eligible Individuals. This program seeks to partner with states to test new payment and delivery system models for dual-eligible individuals.

There are a variety of opportunities to consider if you have an interest in testing out a concept of your own design or one described above. To learn more about these programs, visit
www.innovations.cms.gov/initiatives or www.massmed.org/acsc. –

Kerry Ann Hayon writes about medical-practice issues for Vital Signs, a publication of the Mass. Medical Society, in which this article first appeared.