The Centers for Medicare & Medicaid Services (CMS) defines an accountable care organization (ACO) as a group “of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve.” CMS further explains that the goal of coordinated care is to help “ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors.”
An ACO that delivers high-quality care more efficiently is able to take advantage of a Medicare savings program that could potentially benefit the practices involved financially. There are a number of options for ACOs including the Medicare Shared Savings Program (MSSP), the Pioneer Model, and the Next Generation ACO Model.
MSSP – ACOs participating in the MSSP have the option of choosing from a number of tracks, depending on their preferred level of risk:
- Track 1 ACOs do not assume downside risk (shared losses) if they do not lower growth in Medicare expenditures.
- Medicare ACO Track 1+ Model (Track 1+ Model) ACOs assume limited downside risk (less than Track 2 or Track 3).
- Track 2 ACOs may share in savings or repay Medicare losses depending on performance. Track 2 ACOs may share in a greater portion of savings than Track 1 ACOs.
- Track 3 ACOs may share in savings or repay Medicare losses depending on performance. Track 3 ACOs take on the greatest amount of risk but may share in the greatest portion of savings if successful.
Pioneer Model – Designed for healthcare providers that are experienced with providing coordinated care for patients, the Pioneer Model enables “provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Savings Program.”
Next Gen – The Next Generation ACO model builds on the experience from other models, including MSSP and the Pioneer Model, with a new opportunity for provider groups that “sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.”