Accountable care organizations (ACO) are promising for the future of delivery system reform, and more supportive and flexible policies for ACOs would encourage more physician participation, the AMA and other health care organizations told the Centers for Medicare & Medicaid Services (CMS) last week.
The AMA joined other physician organizations along with hospitals, medical group practices and health care leaders in a group convened by the National Association of ACOs and Premier Healthcare Alliance representing the majority of ACOs participating in the Medicare Shared Savings Program. The group sent joint recommendations to CMS to ensure continued and increased participation in the ACO program to advance delivery system reform, improve the quality of patient care and reduce health care costs. So far, Medicare ACOs have generated more than $705 million in savings.
More than 7.8 million patients receive care from physicians who are participating in an ACO, according to CMS. In three years, there are already half as many patients engaged with ACOs as are enrolled in longstanding Medicare private plans. More than half of the ACOs participating in the Medicare Shared Savings Program generated savings within its first year—but only one in four were able to begin recouping money they had invested in transitioning to a new delivery model.
To maximize the impact of Medicare ACOs on quality and costs, CMS needs to balance its efforts to promote greater ACO accountability for spending and health outcomes with additional policy options to keep current ACOs in the program and attract new participants. This approach will ultimately generate the most savings for Medicare, in comparison to the status quo under the traditional program, and is more likely to improve the quality of care, the group told CMS.
The group recommended that CMS:
- Provide options that will allow ACOs to have more predictability in their patient populations and budgets
- Offer an array of financial accountability options to ACOs related to minimum savings thresholds, shared savings and loss percentages and alternative payment models
- Provide flexibility for specialist physicians who want to participate in more than one ACO and allow physicians to choose, on an individual basis, whether or not to have their primary care services included in ACO patient assignments
- Allow waivers from certain Medicare policies to eliminate barriers to care coordination
- Reward ACOs for quality performance and improvement
The suggestions come in response to CMS’ draft regulations for governing ACOs, released in December.
Learn more about ACOs and other new payment models on the AMA’s Web page.
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