HHS announces new incentives for providers to work together through Accountable Care Organizations when caring for people with Medicare

HHS announces new incentives for providers to work together through Accountable Care Organizations when caring for people with Medicare
New tools help doctors and other health care providers improve quality of care

People with Medicare will be able to benefit from a new program designed to encourage primary care doctors, specialists, hospitals, and other health care providers to coordinate their care under a final regulation issued today by the Department of Health and Human Services (HHS).  Created by the Affordable Care Act, these final rules on Accountable Care Organizations add to the menu of options for providers looking to better coordinate care for patients and will make it easier for providers to deliver high quality care and use health care dollars more wisely.

The initiatives announced today are just two of several efforts made possible by the Affordable Care Act to help bring better health, better care and lower costs not just to Medicare beneficiaries, but to all Americans.  For example, the Bundled Payments for Care Improvement Initiative and Comprehensive Primary Care Initiative offer alternatives to coordinate and improve health care.

Health and Human Services Secretary Kathleen Sebelius

“Today we have taken another step to improve health care for people with Medicare,” said HHS Secretary Kathleen Sebelius.  “We are excited to give doctors, hospitals and other providers the flexibility and support they need to work together and focus on making sure patients get the care they need.”

“This model of delivering care may not be right for everyone, but it provides new incentives for doctors, hospitals, and other health care providers to work together in new ways,” said Secretary Sebelius.

The two initiatives launched today – the Medicare Shared Savings Program and the Advance Payment model – will help providers form Accountable Care Organizations and reflect the significant input provided by stakeholders as well as lessons learned by innovators in care coordination in the private sector.

• The Medicare Shared Savings Program will provide incentives for participating health care providers who agree to work together and become accountable for coordinating care for patients.  Providers who band together through this model and who meet certain quality standards based upon, among other measures, patient outcomes and care coordination among the provider team, may share in savings they achieve for the Medicare program.  The higher the quality of care providers deliver, the more shared savings the providers may keep.

• The Advance Payment model will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program who also would benefit from additional start-up resources to build the necessary infrastructure, such as new staff or information technology systems.  The advanced payments would be recovered from any future shared savings achieved by the Accountable Care Organization.

“As a physician I understand the complexities of caring for a patient who may have multiple providers,” said Donald M. Berwick, M.D., administrator of the Centers for Medicare & Medicaid Services (CMS).  “This opportunity to coordinate care among providers could greatly improve the quality of care Medicare beneficiaries receive.”

Both the Medicare Shared Savings Program and Advance Payment model create incentives for health care providers to work together to treat an individual patient across care settings – including doctors’ offices, hospitals, and long-term care facilities.

Unlike a managed care plan, Medicare beneficiaries will not be locked into a restricted panel of providers.  Rather, a determination of whether an Accountable Care Organization was responsible for coordinating care for a beneficiary will be based on whether that person received most of their primary care services from the organization.

“We listened very carefully to the more than 1,300 comments we received on the proposed rule released this spring, and this final rule includes a number of improvements suggested by those comments that will strengthen the program,” Dr. Berwick said.  “For example, the final rule will increase the incentives and streamline the Shared Savings Program, extending the benefits of the new program to a broader range of beneficiaries.”

Other changes from the proposed rule include making the one-sided model truly one-sided, expanding participation to Rural Health Clinics and Federally Qualified Health Centers and organizations where specialists provide primary care, and providing a flexible starting date in 2012.  Federal savings from this initiative could be up to $940 million over four years.

To aid organizations interested in becoming Accountable Care Organizations, CMS offers a number of learning opportunities for providers, including the third Accelerated Development Learning Session on November 17-18 in Baltimore.  This free session will offer providers the opportunity to learn more about this option for providing care.  For more information, visit https://acoregister.rti.org/.

People with Medicare have received information about what an Accountable Care Organization could mean for them in the annual issue of “Medicare & You” and if their current health care provider is participating in an Accountable Care Organization, they will receive additional information from their provider.

The Shared Savings Program final rule can be found at: http://www.HealthCare.gov/law/resources/regulations/index.html. (See Final Rule on Shared Savings Program: Accountable Care Organizations)

The Advanced Payment solicitation is posted at: http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment/.

For more information, fact sheets are posted at: http://www.HealthCare.gov/news/factsheets/2011/10/accountable-care10202011a.html and http://www.cms.gov/ACO/.

The joint CMS and Department of Health and Human Services Office of Inspector General (OIG) Interim Final Rule with Comment Period addressing waivers of certain fraud and abuse laws in connection with the Shared Savings Program can be found at:  http://www.HealthCare.gov/law/resources/regulations/index.html. (See Request for Public Comment on Final Waivers in Connection with the Shared Savings Program).

The Antitrust Policy Statement is posted at: www.ftc.gov/opp/aco/ andhttp://www.justice.gov/atr/public/health_care/aco.html.

The Internal Revenue Service (IRS) Fact Sheet, Tax-Exempt Organizations Participating in the Medicare Shared Savings Program through Accountable Care (FS-2001-11), is posted at: http://www.irs.gov/newsroom/article/0,,id=248490,00.html.

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Several efforts were made possible by the Affordable Care Act to help bring better health, better care and lower costs not just to Medicare beneficiaries, but to all Americans.

When doctors and other health care providers can work together to coordinate patient care, patients receive higher quality care and we all see lower costs.  Thanks to the Affordable Care Act, healthcare providers have a range of ways to partner with the Centers for Medicare & Medicaid Services (CMS) to get new support and resources to do just that.  There are options for healthcare providers of all sizes, types, all across the country.

Partnership for Patients: CMS has dedicated up to $1 billion over three years to test care models to reduce hospital-acquired conditions and improve transitions in care. This publicprivate partnership supports the efforts of physicians, nurses and other clinicians to make care safer and better coordinate patients’ transitions from hospitals to other settings. The CMS Innovation Center will aid dissemination of proven methods for dramatically reducing both harm caused in hospitals and preventable hospital readmissions. To date, over 6,000 organizations— including more than 3,000 hospitals—have joined the Partnership for Patients and pledged to support its goals. The partnership has the potential to save 60,000 lives and reduce millions of preventable injuries and complications in patient care over the next three years and save up to $50 billion over 10 years;

Bundled Payments for Care Improvement:  The Bundled Payments for Care Improvement initiative seeks to improve patient care by fostering improved coordination through four broadlydefined, patient-centered approaches.  Three models involve a retrospective bundled payment arrangement, and one model would pay providers prospectively. Through the Bundled Payments initiative, providers have great flexibility in selecting conditions to bundle, developing the health care delivery structure, and determining how payments will be allocated among participating providers.

Comprehensive Primary Care Initiative: This initiative will help primary care practices deliver higher quality, more coordinated and patient-centered care in a handful of selected
markets. In addition to regular fee-for-service payments, CMS will pay primary care practices a monthly fee for clinicians to: help patients with serious or chronic diseases follow personalized care plans; give patients 24-hour access to care and health information; deliver preventive care; engage patients and their families in their own care; and to work together with other doctors, including specialists, to provide better coordinated care. Under the initiative, Medicare will work with private and State health insurance plans to offer similar support to primary care practices that better coordinate care for their patients.

Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration: This demonstration evaluates the impact of advanced primary care practice on improving care, focusing on prevention, and reducing healthcare costs among Medicare beneficiaries served by FQHCs. It will assess the impact that additional support has on FQHCs’
ability to transform their practice and become formally recognized as a patient-centered medical home. This demonstration, operated by the CMS Innovation Center in partnership with the Health Resources Services Administration (HRSA), will test the effectiveness of doctors and other health professionals working in teams to coordinate and improve care for up to 195,000 Medicare patients.

Medicare Shared Savings Program for Accountable Care Organizations (ACOs): The Medicare Shared Savings Program will allow providers who voluntarily agree to work together to coordinate care for patients and who meet certain quality standards to share in any savings they achieve for the Medicare program.  ACOs which elect to become accountable for shared losses have the opportunity to share in greater savings. ACOs will coordinate and integrate Medicare services, with success being gauged by roughly 30 quality measures organized in four domains. These domains include patient experience, care coordination and patient safety, preventive health and at-risk populations. The higher the quality of care providers deliver, the more shared savings their Accountable Care Organization may earn, provided they also lower growth in health care expenditures.

Advance Payment Accountable Care Organization Model:   The Advanced Payment model will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program who also would benefit from additional start-up resources to build the necessary infrastructure, such as new staff or information technology systems. The advance payments would be recovered from shared savings achieved by the Accountable Care Organization.

Pioneer Accountable Care Organization Model: The Pioneer model is an initiative complementary to the Medicare Shared Savings Program designed for organizations with experience providing integrated care across settings. The Pioneer Model tests a rapid transition to a population-based model of care, and engages other payers in moving toward outcomes-based
contracts. The initial group of Pioneer sites, slated to be announced later this year, will be positioned to rapidly demonstrate what can be achieved when we provide highly coordinated care to Medicare fee-for-service beneficiaries.

Financial Models to Support State Efforts to Integrate Care for Medicare-Medicaid Enrollees: A longstanding barrier to coordinating care for Medicare-Medicaid enrollees has been the financial misalignment between Medicare and Medicaid. This initiative will test two models – a capitated model and a managed fee-for-service model — for States to better align the
financing of the Medicare and Medicaid programs and integrate primary, acute, behavioral health and long term services and supports for Medicare-Medicaid enrollees. For those States that are interested in testing these two models, CMS is offering streamlined approaches and technical assistance to support necessary planning activities.

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* The above story is adapted from materials provided by USA Department of Health and Human Services (HHS)
** More information at USA Department of Health and Human Services (HHS)