The Centers for Medicare and Medicaid Services has announced two new changes to the design of the ACO Investment Model.
As of June 25, the eligibility criteria for the model have changed to include Medicare Shared Savings Program ACOs that started on January 1, 2015 and to provide greater opportunities for rural ACOs to participate.
These two changes will newly allow ACOs starting in the Medicare Shared Savings Program in 2015 to apply in the upcoming application round, and it will remove the 10,000 or fewer assigned beneficiary eligibility criteria for rural ACOs that started in the Medicare Shared Savings Program in 2015 (or will start in 2016), writes Patrick Conway, M.D., CMS chief medical officer, in a blog. These two changes reflect the CMS Innovation Centers commitment to listening to suggestions and ensuring that demonstrations are widespread, including rural providers and smaller physician groups.
The ACO Investment Model tests the use of pre-paid or upfront shared savings to reduce capital commitments and encourage new ACOs to form in rural and underserved areas, and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk. For ACOs that started in the Medicare Shared Savings Program in 2014, 2015 or will start in 2016, the application period will open on July 1.
Because some providers lack access to capital needed to support population health management, CMS will provide financial support to these ACOs to make infrastructure investments and develop new ways to improve care for Medicare beneficiaries. For example, ACOs may need to invest in data warehouses to generate patient registries or hire new staff to provide intensive care management services.
According to Conway, the ACO Investment Model is expected to provide a total of $114 million in upfront investments to up to 75 ACOs nationwide. Making payments of shared savings in both upfront and ongoing amounts will help these ACOs invest in care coordination, health information technology, and population health platforms to help shift our healthcare system from one that provides reactive care to one that provides proactive, preventive care, he writes.
Additional information, including eligibility criteria and application forms, are available here.
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