A recent press release from the Centers for Medicare & Medicaid Services (CMS) publicizes the growth of the accountable care organization (ACO) movement, as 69 newly formed ACOs started participating in the Medicare Shared Savings Program (MSSP) this year. That brings the total of ACOs participating in the MSSP to 480.
“One of CMS’ top priorities is to expand access to quality, affordable health coverage and care,” said CMS Administrator Chiquita Brooks-LaSure. “Accountable care initiatives – which give more tools to health care providers to deliver better care and help people receive more coordinated care – through programs like the Medicare Shared Savings Program … care initiatives are critical to achieving this vision.”
What is an ACO?
An accountable care organization (ACO) is a group of health care providers, hospitals, and other healthcare professionals with a determined focus on improving the quality and coordination of care while managing the cost of care for their population. As part of the larger value-based care movement, ACOs agree to take responsibility for the health outcomes and spending of a defined patient population. Medicare patients and underserved populations, including those in rural areas. ACOs must meet various reporting and performance measures to ensure they are providing high-quality care that meets the needs and preferences of their patients.
Benefits of ACO Participation
ACOs receive financial incentives and share in the savings if they meet certain quality and cost benchmarks, while also facing penalties if they exceed the spending targets. A new MSSP permanent payment option beginning in 2024 enables ACOs to receive more than $20 million in advance investment payments (AIPs) for caring for underserved populations.
ACOs seek to align the incentives of providers and payers, and foster collaboration and integration across different settings and specialties. ACOs also aim to promote preventive and primary care, reduce unnecessary hospitalizations and readmissions, and improve care transitions and chronic disease management.
Types of ACOs
ACOs vary in their size, structure, governance, and scope of services. Some ACOs are led by physicians, others by hospitals, and some by both. Some ACOs focus on specific clinical areas, such as kidney care or oncology, while others cover a broader range of services. ACOs also differ in their level of risk and reward, depending on the type of contract they have with Medicare or other payers. Some ACOs only share in the savings, while others also assume downside risk.
CMS is focused on growing three ACO initiatives, intended to address the needs of patients with Traditional Medicare: the Medicare Shared Savings Program (the permanent ACO program); the ACO REACH model, focused on access and care for underserved populations; and the Kidney Care Choices model.
What is Vytalize ACO?
Vytalize Health is an ACO that participates in the MSSP. Through its partnership with NextGen Healthcare, Vytalize helps clients more easily achieve available financial benefits. By joining Vytalize, practices get the benefits of NextGen® Population Health without purchasing the software. In addition to an annual distribution based on shared savings, practices participating in Vytalize ACO receive monthly bonus payments.
To find out more about how NextGen Healthcare and Vytalize can help your practice succeed under value-based, reach out to your account manager. You can also contact NextGen Healthcare at 855-510-6398 or results@nextgen.com.