Three of the national associations most fully involved in helping their member provider organizations move forward into accountable care organization (ACO) development and value-based contracting released a joint statement on Tuesday asking federal healthcare officials to make the Next Generation ACO model a permanent part of the Medicare Shared Savings Program.
America’s Physician Groups (APG), the National Association of ACOs (NAACOS), and Premier Inc. joined together to write a public letter asking Health & Human Services Secretary Alex Azar and Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS) to take that step. As the press release announcing the sending of that letter stated, “Today three health care organizations leading the charge on value-based payment reform asked Health & Human Services (HHS) Secretary Alex Azar to make the Next Generation Accountable Care Organization (Next Gen ACO) Model a permanent part of the Medicare Shared Savings Program (MSSP). The HHS Secretary has the authority to certify Center for Medicare & Medicaid Innovation (Innovation Center) demonstrations as permanent fixtures in Medicare if the models save money and improve quality. America’s Physician Groups (APG), the National Association of ACOs (NAACOS), and the Premier healthcare alliance sent a letter to Azar and Centers for Medicare & Medicaid Services Administrator Seema Verma highlighting how the program meets that criteria.”
As the three organizations wrote in the letter, “The undersigned organizations write to urge the Department of Health & Human Services (HHS) to make the Next Generation Accountable Care Organization (Next Gen ACO) Model a permanent, voluntary program within the Medicare Shared Savings Program. In addition, the CMS Center for Medicare & Medicaid Innovation (Innovation Center) should implement program changes that will increase the model’s stability and sustain robust participation. These changes are particularly important,” the organizations wrote, “as the Innovation Center will soon open the application cycle for the new Direct Contracting Model. Many Next Gen ACOs are currently weighing their participation options. Having assurance that their model would continue past the current sunset date of December 31, 2020 would benefit Next Gen ACOs and those interested in joining the existing program or the new Direct Contracting Model.”
As the associations noted, “We strongly support the Innovation Center’s work in developing the Direct Contracting Model, which will provide another accountable care option for those ready for capitation and high levels of risk and reward. We look forward submitting additional feedback on the Direct Contracting Model and working with our members and the Centers for Medicare & Medicaid Services (CMS) to support its successful implementation. Our recommendations in this letter reflect our unified desire to see Medicare ACO programs achieve the long-term sustainability necessary to enhance care coordination for millions of beneficiaries, lower the growth rate of healthcare spending and improve quality in the Medicare program. We believe the Next Generation ACO Model provides an important step on the risk progression from the current Medicare Shared Savings Program (MSSP) Pathways to Success options to the new Direct Contract Model.”
Among the associations’ specific recommendations: “CMS should incorporate true capitated payment approaches within the Next Gen model, starting with primary care capitation”; “Including a cap and a coding adjustment factor is duplicative and penalizes ACOs”—“therefore, ACOs should not face an unrealistic cap on risk score increases but would have risk scores adjusted annually through a Medicare Advantage-like process designed to address changes in coding practices”; CMS needs to “provide attribution and financial reconciliation preference to longitudinal, total-cost-of-care models, which are at the greatest financial risk”; “CMS should explore a tiered benchmarking methodology, where benchmarks are increased for low-cost regions and decreased for high-cost regions”; and CMS needs to “promote flexibilities to enhance care coordination and manage risk.”
