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In the last five years, the country has experienced incredible growth in Medicare accountable care organizations (ACOs), as the healthcare industry inevitably moves toward value-based payment and care delivery models. Between the Medicare Shared Savings Program (MSSP), the Next Generation ACO model and other shared savings initiatives, the Centers for Medicare & Medicaid Services (CMS) estimates that more than 12.3 million Medicare and/or Medicaid beneficiaries are served by an ACO.
Solidifying the growth of ACOs and other value-based payment models is the implementation of the physician payment segment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which is called the Quality Payment Program (QPP).
The QPP represents an inflection point in healthcare for clinicians, hospitals and health systems, placing significant revenue at stake and incentivizing assumption of risk under alternative payment models, such as ACOs. This value-based paradigm creates opportunities for health systems to enter into new, integrated arrangements with independent clinicians. Value-based payment arrangements like these are already paying off with Medicare ACOs saving nearly $1.3 billion since 2012, while simultaneously improving quality.
Though the industry is moving in this direction, some providers are uncertain about when they should begin building value-based payment models. What many don’t know is that MACRA’s QPP and Medicare ACOs are well-aligned.
Under the QPP, clinicians have the ability to participate in either the Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (APM). MIPS is essentially a value-based payment model that provides for a bonus or penalty depending on performance in four categories – quality, cost, improvement activities and advancing care information. Because participating in an Advanced APM requires accepting a large amount of actuarial risk (meaning few clinicians will qualify), CMS has created a third track that combines the MIPS and APM options and includes a Medicare ACO, such as MSSP Track 1. That’s why now is the right time to engage in a Medicare ACO – plus, there’s no downside risk involved.
Breaking It Down: Six Reasons Why a Medicare ACO is Right For You
With all the advantages of a Medicare ACO and no downside risk involved, now is the time to join other industry leaders and position your organization for success. But deadlines are looming. If you’re even considering becoming a participant, you must send CMS a notice of intent to apply by Wednesday, May 31.
Download our whitepaper for more on the MIPS-APM option and how it aligns with MSSP Track 1.