There have been some recent developments in the world of accountable care organizations (ACOs).
First, the Centers for Medicare & Medicaid Services (CMS) announced last month that there are two new ACO models under the Medicare Shared Savings Program (MSSP) – the Medicare-Medicaid ACO (MMACO) model and the MSSP Track 1+ model (see CMS Announces Two New ACO Models). The MMACO model was built to serve dual eligible beneficiaries through Medicare and state Medicaid program partnerships. CMS will partner with six states that have a large proportion of dual eligibles currently enrolled in Medicaid fee-for-service (FFS). The MSSP Track 1+ model was developed to support clinical professionals participating in MACRA’s Quality Improvement Program. Under the model, ACOs will be eligible to share up to 50% of the savings, but be prepared to share up to 30% of the losses (capped at 8%). Applications to participate in Track 1+ will follow the regular application schedule for the MSSP.
Second, this month the Louisiana Department of Health (LDH) invited ACOs to participate in the state’s Medicaid managed care procurement for 2019, and is considering contracting with ACOs as part of a larger effort to move Medicaid payments from a pay-for-volume to a pay-for-value structure (see Louisiana Considering Medicaid ACO Program For 2019; RFI Released). Louisiana is the sixteenth state that has developed or is planning to develop a Medicaid ACO program (see The 2016 OPEN MINDS Medicaid ACO Trend Update).
You may be asking, will ACOs continue to be part of the CMS strategy for Medicare under the Trump Administration, or will they become less important in the years ahead? It’s too early to tell about the specifics of the new administration and Medicare ACOs. But I would argue that the concept of “accountable care” defined as “performance-based reimbursement to a group of provider organizations,” is here to stay. Even if the Medicare-sponsored programs are not renewed, there is enough traction among state Medicaid plans and commercial health plans to shift their contracting with more accountability and gainsharing with provider organizations. In fact, a quick look into the OPEN MINDS ACO database finds that out of a total of 689 ACOs, eight percent (55) are Medicaid ACOs and 33% (229) have commercial contracts.
Whether the name of the construct is “ACO” or something else, the general view of health plan and health policy executives is that there is no retreat from pay-for-value contracting models (see There Is No Plan B). And for specialty provider organizations, the strategy opportunities and challenges remain the same in a world of health plans, just as in a world of ACOs.
For more on preparing, see these great presentations from our recent executive institutes about developing new relationships with (and new service lines for) health plans and ACOs:
- Payer-Provider Collaboration: The Value Of Data Sharing For Whole Person Care
- Strategies, Tools & Techniques That Enable Payer-Provider Collaborations & Partnerships
- How To Create Successful Partnerships with Managed Care Organizations
- Using Medicare Star Ratings & HEDIS Scores To Develop New Opportunities With Health Plans
And for the latest on both Medicare and Medicaid ACOs, be sure to check out our 2016 market intelligence reports – The 2016 OPEN MINDS Medicaid ACO Trend Update and The 2016 OPEN MINDS Medicare ACO Update: A Three-Year Trends Report.
For a deeper dive, join me on February 21 in Clearwater, Florida, where I will be moderating the mhca 2017 Winter Conference Innovation Incubator discussion session, “Opportunities For Behavioral Health Services In Integrated Care,” featuring Mary Monnat, President/CEO, LifeWorks Northwest, and Rebecca Plonsky, LICSW, Vice President of Integrated Behavioral Health, Prospect CharterCare LLC.