Physicians and healthcare providers have formed 106 new accountable care organizations, ensuring as many as 4 million Medicare beneficiaries access to high-quality, coordinated care across the United States, the Department of Health and Human Services announced Jan. 10.
Doctors and healthcare providers can establish ACOs to work together to provide higher-quality care to their patients. Since passage of the Affordable Care Act, more than 250 ACOs have been established. Beneficiaries using ACO-affiliated providers retain the freedom to choose providers inside or outside the ACO, which shares with Medicare any savings generated from slowing the growth in healthcare costs while meeting standards for quality of care.
ACOs must meet quality standards to ensure savings are achieved through improving care coordination and providing care that is appropriate, safe and timely. The Centers for Medicare & Medicaid Services has established 33 quality measures on care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations and patient and caregiver experience of care (a list of the measures is available at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/ACO_Quality_Factsheet_ICN907407.pdf). Federal savings from the initiative could total $940 million over four years, according to HHS.
The new ACOs include a diverse cross-section of physician practices across the country. Roughly half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. About 20% of ACOs include community health centers, rural health centers and critical access hospitals that serve low-income and rural communities.
The new group also includes 15 Advance Payment Model ACOs, which are physician-based or rural providers who would benefit from greater access to capital to invest in staff, electronic health record systems or other infrastructure required to improve care coordination. Medicare will recoup advance payments over time through future shared savings.
CMS in 2012 launched the Pioneer ACO program for large provider groups able to take greater financial responsibility for the costs and care of their patients over time. In total, Medicares ACO partners will serve more than 4 million beneficiaries nationwide this year.
For a PDF of the 106 new ACOs, visit http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/2013-ACO-Contacts-Directory.pdf. Additional information about the Advance Payment Model is available at www.innovations.cms.gov/initiatives/ACO/Advance-Payment/index.html.
The next application period for organizations that wish to participate in the Medicare Shared Savings Program via an ACO is this summer, with a January 2014 start date. More information is available at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram/.