Hopeful Reactions to CMS’s Unveiling of the Details of Its Next Generation ACO Program

Jan. 12, 2016
Industry leaders helping to facilitate ACO development see the formal unveiling of CMS’s Next Generation ACO Program as a step in the right direction for U.S. healthcare

In the hours following the unveiling on January 11 of the detailed parameters of and participants in the Next Generation ACO Program, on the part of the federal Centers for Medicare & Medicaid Services (CMS), provider groups and associations began to make statements on the program, the newest one developed to engage providers to develop accountable care organizations.

The Charlotte-based Premier, Inc. released an extensive statement, which it attributed to Joe Damore, vice president of population health for the alliance. The statement began, “The Premier healthcare alliance congratulates newly-approved and renewing ACOs for their selection by CMS for the next round of the Medicare Shared Savings (MSSP) and the Next Generation ACO (NGACO) programs. For several months,” the statement continued, “Premier worked with 14 applicants as part of our MSSP and NGACO Application Cohorts. We are delighted that all 14 members submitting applications were chosen for participation, continuing our 100% success rate across these cohorts.  Since we began helping organizations with their applications, we’ve helped approximately 60 organizations successfully apply to these programs.“

And, the Premier statement added, “The continued growth of voluntary Medicare ACO programs, coupled with upcoming alternative payment models authorized through the Medicare Access and CHIP Reauthorization Act (MACRA), sends a clear signal that a majority of providers will be participating in at least some form of value-based reimbursement in the future. With aligned incentives in place across the care continuum, we are confident that our healthcare system will have greater flexibility and the ability to innovate for improved community health.”

Meanwhile, the White Plains, N.Y.-based Universal American Corp., a healthcare management company, through its subsidiary, Collaborative Health Systems, released a statement confirming that one of its ACOs formed in partnership with primary care physicians, the Accountable Care Coalition of Southeast Texas (ACCSETX), had been chosen by CMS to participate in the Next Generation ACO Program.

“In partnership with Collaborative Health Systems (CHS), a Universal American subsidiary, the 118 providers of ACCSETX will serve more than 12,500 Medicare beneficiaries as a Next Generation ACO,” Universal American Corp. noted. “The selection recognizes the long history and success these physicians have had in coordinating care to improve healthcare outcomes while lowering costs through value-based arrangements, such as Medicare Shared Savings Program ACOs and Medicare Advantage plans. These same physicians work with TexanPlus, Universal American’s four-star Medicare Advantage plan in Southeast Texas.”

Further, the Universal American statement said, “Under the Next Generation ACO Model, ACCSETX primary care physicians will have stronger financial incentives and tools at their disposal to engage beneficiaries and provide care outside the customary requirements of Medicare Fee-For-Service. For instance, telemedicine services received at a beneficiary’s home will be covered and allow physicians to offer care through telephonic, online, and other electronic communications. Enhanced access to skilled nursing facilities will enable beneficiaries to enter a facility without a three-day inpatient hospital stay.”

Louis Roddy, M.D., member of the ACCSETX Board of Directors, was quoted in the statement about the recent announcement and the opportunity for primary care physicians. “We are thrilled to be chosen for this innovative new model which gives primary care physicians additional tools and incentives to coordinate care for their Medicare Fee-For-Service beneficiaries,” he said. “We look forward to sharing our results as we join with other Next Generation ACOs around the country to demonstrate our ability to positively change the healthcare equation.”

And Richard Barasch, chairman and CEO of Universal American, told HCI Editor-in-Chief Mark Hagland that “We were one of the early adopters of the MSSP [Medicare Shared Savings Program] program, and we see this”—the unveiling of the full Next Generation ACO Program—“as a conceptual advance, because it’s allowing us to build preferred networks alongside our primary care physicians, so that we can build a high-performing network of physicians. I see CMS and the [Obama] Administration,” he said, “trying to work off of the fee-for-service chassis and improve it, and give providers more leeway and allow them to get creative in serving beneficiaries, and saving money for the government.”

Does it help that the Next Generation ACO Program has created prospective measures to help guide providers? “Yes, it does,” Barasch said. “You could argue that question both ways; as long you know who you’re going to be—that is what is important.” Meanwhile, with regard to the ACCSETX physicians, he said, “These doctors have been in value-based programs through Medicare Advantage program for a decade. And they were in the MSSP originally. And now they’re taking more risk and more upside with this program, which they’re happier to do.”

He added that “These are primary care doctors, and we’ve been working with many of them for a long time. They’re high performers, they know what it takes to provide high quality and reduce cost. They’re very proactive with their members. They know how to put them into the right levels of care at the right cost”—in other words, they know very well how to do strong and effective care management of patients.

What about the IT and analytics aspects of success in CMS ACO programs? “We’ve spent a ton of resources building analytics for the MSSP program,” he noted. “You need to know which members need help and which providers need help in caring for patients. So, getting all the data you need—EMR, hospital, lab, and drug data—the more you can get those kinds of data, the better.”

As for how he saw things playing out for ACCSETX  in the next few years in the Next Generation ACO program,  as well as for the 25 ACOs that Universal American is helping to manage, Barasch said, “We’re very optimistic that the Next Gen construct is a good one. We think that MSSP will continue to evolve in a positive way. And we expect to continue to be active in the program. And we believe that this Administration, and this is non-political: frankly, this is just common sense—that there will be a movement towards bringing value-based care to the fee-for-service program. It’s in everybody’s interest.”