The ACO challenge…
- Catherine M. Zito, FHFM, CPA, CPC
- Jun 18, 2018
- 2 min read
Accountable Care Organizations (ACOs) manage the care of over 32 million patients nationwide and despite their growth over the past few years, they are still learning how to be successful. Two years ago, CMS created the Next Generation (NextGen) model which was intended to provide experienced ACOs the opportunity to take on greater risk with potentially greater rewards. Seven of the original fifty eight ACOs participating in the NextGen model left the program after the first year results were announced. Many of the organizations that left the model claim that the changes to risk adjustment calculations during the term of the agreement made it impossible for them to manage the risk. Others claimed that the NextGen financial model is structured on improved performance rather than sustained low cost performance resulting in penalties to ACOs that already deliver high-quality, low-cost care.
The real ACO challenge is how to successfully deliver high-quality, low-cost care within the constraints of the current programs offered. If an ACO is experienced and successful, they will naturally want to take on additional risk for the potential upside rewards. This can only be achieved if the rules remain the same throughout the term of the agreement.
Are you ready to take on additional risk through participation in an ACO model that has both upside and downside risk? Here are some ways to evaluate your readiness.
Do you have a solid care coordination platform?
Are you staffed with adequate care coordinators?
Are your providers knowledgeable on population health strategies?
Do you share information readily with the entire care team?
If you answered “yes” to the majority of these questions, the next step is to perform a full readiness assessment. Once you engage in a contract with downside risk be sure to carefully examine the participation agreement to insure that the rules will not change mid-term and continue to advocate for the development of innovative financial models that encourage high-quality, low-cost care.