If you are a Medicare beneficiary seeking information about this model,
please review the section below titled
I'm a Medicare Beneficiary, so what does this mean for me?
Background
Medicare ACOs are comprised of groups of doctors, hospitals, and other
health care providers and suppliers who come together voluntarily to provide
coordinated, high-quality care at lower costs to their Original Medicare
patients. ACOs are patient-centered organizations where the patient and
providers are true partners in care decisions. Medicare beneficiaries
will have better control over their health care, and providers will have
better information about their patients’ medical history and better
relationships with patients’ other providers. Provider participation
in ACOs is purely voluntary, and participating patients will see no change
in their Original Medicare benefits and will keep their freedom to see
any Medicare provider. When an ACO succeeds in both delivering high-quality
care and spending health care dollars more wisely, it will share in the
savings it achieves for the Medicare program.
Model Details
The Next Generation ACO Model is an initiative for ACOs that are experienced
in coordinating care for populations of patients. It will allow these
provider groups to assume higher levels of financial risk and reward than
are available under the current Pioneer Model and Shared Savings Program
(MSSP). The goal of the Model is to test whether strong financial incentives
for ACOs, coupled with tools to support better patient engagement and
care management, can improve health outcomes and lower expenditures for
Original Medicare fee-for-service (FFS) beneficiaries.
Included in the Next Generation ACO Model are strong patient protections
to ensure that patients have access to and receive high-quality care.
Like other Medicare ACO initiatives, this Model will be evaluated on its
ability to deliver better care for individuals, better health for populations,
and lower growth in expenditures. This is in accordance with the Department
of Health and Human Services’ “Better, Smarter, Healthier”
approach to improving our nation’s health care and setting clear,
measurable goals and a timeline to move the Medicare program -- and the
health care system at large -- toward paying providers based on the quality
rather than the quantity of care they provide to patients. In addition,
CMS will publicly report the performance of the Next Generation Pioneer
ACOs on quality metrics, including patient experience ratings, on its website.
Quality and financial results are provided for Performance Year 1 (2016):
Performance Year 1 (2016) (XPS)
The Model will consist of three initial performance years and two optional
one-year extensions. Specific eligibility criteria are outlined in the
Request for Applications (PDF). Questions regarding the Next Generation
ACO Model can be directed to
NextGenerationACOModel@cms.hhs.gov.
Benefit Enhancements
Benefit enhancements are waivers of certain Medicare service rules (i.e.,
telehealth, post-discharge home visits, and the three-day skilled nursing
facility rule), and initiatives intended to assist Next Generation Accountable
Care Organizations in improving care for and engagement of their beneficiaries.
I'm a Medicare Beneficiary, so what does this mean for me?
Additional Information