Next Generation ACOs take on greater financial risk than other programs, such as the Medicare Shared Savings Program, and in return are offered greater flexibility for care coordination. But they've also faced blowback, with some calling for these models to be scrapped or severely overhauled because the promised savings slow to materialized
So 29 participants in the Centers for Medicare & Medicaid Services Next Generation ACO program—including Dartmouth-Hitchcock Medical Center, Henry Ford Health System, Mission Health, Carillion Clinic and Trinity Health—are teaming up to work with the agency to ensure the model stays in place for the long-term.
“Taking the lessons learned in particular with this group—the most advanced of the ACO portfolio—and getting that information out will benefit the other Next Gens and the broader healthcare system,” said Mara McDermott, vice president of federal affairs at America’s Physician Groups, in an interview with FierceHealthcare.
The coalition offers an opportunity to showcase the positives of the ACOs, which have been criticized for not producing quick savings, McDermott said.
Next Gen, in particular, lost several high profile participants in 2016, raising questions about its future. But since then, it’s rebounded, and more than doubled enrollment in 2017. Recent data from CMS shows that Next Generation ACOs saved Medicare $62 million in 2016, and wellness visits increased by 12%
That trend is reflected Trinity Health, which has deployed the Next Gen model at four of its 23 integrated delivery networks and participates in other advanced payment models at other locations.
Emily Brower, the system’s senior vice president for clinical integration and physician services, told Fierce that about 90,000 patients are enrolled in the Next Gen program. Care for high-risk patients is often very fragmented, Brower said, so those who become ACO patients experience enhanced care coordination. For example, high-risk patients are being diverted more frequently to primary care and preventive screenings, she said.
“Our focus has really been on deploying care coordination for those highest-need, highest-risk patients,” Brower said. “What we’ve seen there is that we are touching more lives and understanding better what our patients need.”
CMS is looking to take Next Gen’s two-sided risk model to other types of ACOs, including MSSP, which has garnered significant backlash from provider groups and insurers. The National Association for ACOs (NAACOs), the American Medical Association and America’s Health Insurance Plans have warned that such changes could deter new ACO entrants and undermine the transition away from fee-for-service.
A NAACOs survey revealed that 71% of ACOs who entered nonrisk Medicare Shared Savings tracks in 2012 and 2013 would leave the program if pushed to take on financial risk.