Accountable Care Organizations (ACOs) have been part of the healthcare landscape for a while and remain an integral part of the move toward value-based medicine. CMS recently introduced a new model in the MSSP (Medicare Shared Savings Program), ACO Track 1+.  This presentation gives a broad overview of ACOs and explains the basics of the new Track 1+ model. Topics include: - ACOs and their role in MACRA/MIPS - Meeting or exceeding the standards - Why the risk might be worth it

2. What are ACOs?
“Accountable Care Organizations (ACOs)
are groups of doctors, hospitals, and
other health care providers, who come
together voluntarily to give coordinated
high quality care to their Medicare
patients.”*
*www.cms.org/aco

3. ACOs:
A Little History
Term was introduced in 2006, but
didn’t go into practice until 2011,
when 32 Medicare “Pioneer” ACOs
were introduced.
Currently, there are 480 participating
ACOs across the U.S.

4. ACO Driving Principle:
The Triple Aim
Improving Patient
Experience of Care
Improving Health of
Populations
Triple
Aim*
Reducing per capita
Cost of Healthcare
*Institute for Healthcare Improvement (www.ihi.org)

5. Who is Eligible*?
ACO professionals (i.e., physicians and certain non-physician
practitioners) in group practice arrangements
Networks of individual practices of ACO professionals
Partnerships or joint ventures arrangements between
hospitals and ACO professionals
Hospitals employing ACO professionals
Certain critical access hospitals
Federally qualified health centers
Rural health clinics
*www.cms.org/aco

6. MACRA
Providers have the opportunity to select
one of four paths to adopt MACRA in 2017
Track 1
Track 2
Track 3
Track 1+

7. Original ACO Track Models
1-sided or 2-sided financial risk
Track 1 - An ACO may receive shared savings
if it meets the applicable requirements, but it
will not be liable for shared losses
Track 2 and Track 3 - The ACO may share
both savings and losses

8. The New Model - Track 1+
Based on the Shared
Savings Program
Track 1
Part of the 2018,
2019, and 2020
Shared Savings
Program
application
cycles.
Will align with
that for Shared
Savings Program
Tracks 1, 2, and 3

9. Track 1+ - Purpose
• Incorporates more limited downside risk than Tracks 2 or 3
• Designed to encourage more practices, especially small
practices, to advance to performance-based risk
• Allows more hospitals, including small rural hospitals,
to participate

10. Track 1+ - Composition
• Incorporates elements of Tracks 1 and 3
• Lower financial risk than certain Medicare ACO options
• Encourages more participants in APMs
• Option to request a Skilled Nursing Facility 3-Day Rule Waiver to
provide greater flexibility to Track 1+ ACOs to better coordinate
and deliver high quality care

11. Risk Arrangements
Revenue- based Benchmark-based

12. Revenue-Based
ACOs in the Track 1+ Model with a revenue-based
loss sharing limit would be offered the option to
accept higher risk in order to continue to be
considered participants in an APM

13. Benchmark-Based
ACO’s loss sharing limit = 4% of the ACO’s updated historical
benchmark
Potentially higher risk than revenue-based loss sharing limit for those
likely to be providing a larger portion of total Part A and B revenue for
their Medicare FFS beneficiaries and therefore likely to be more able
to assume a higher level of risk
Provides lower risk than Track 2 and 3. Under Track 3 the loss limit is
15 percent of the ACO’s updated benchmark while under Track 2, the
loss limit is phased in over three years starting at 5 percent of the
ACO’s updated benchmark in year 1, 7.5 percent in year 2, and 10
percent in year 3 and any subsequent year.

14. Eligibility
An ACO must concurrently participate in Track 1 of the
Shared Savings Program
New ACOs and renewing Shared Savings Program Track 1
ACOs may also apply to participate in this Model
Open to Shared Savings Program Track 1 ACOs that are
within their current agreement period, new applicants, or
those renewing their participation agreement that meet
the eligibility criteria of the Track 1+ Model
*Track 2 and 3 ACOs are not eligible for the Model

15. How to Apply
Follows the same timeline
as all MSSP applications
submit Notice of Intent to Apply (NOIA) in
May 2017

16. Commitment
ACO’s participation in the Model
will be limited to one full three-
year agreement period
New entrants, renewing ACOs, and
those transitioning during their
existing Track 1 period could have
opportunity to renew for three-
year agreement under this model

17. Education and Support
Webinars
Fact Sheets
Open Forums
CMS Education and Training

18. Industry Reaction
Tom Nickels
EVP for government relations and public policy
American Hospital Association
"This new ACO model will allow hospitals and clinicians to
partner to provide high-quality, cost-efficient care for patients
without incurring the unsustainable financial risk that current
ACO models require," he said, adding, "We have recommended
CMS better balance risk and reward for its ACO models, and
based on the details in the CMS fact sheet, Track 1+ is a move in
the right direction.”*
Industry Reaction
*www.advisory.com

19. APM Path
Qualifying Participants Earn a
5%
incentive payment in 2019*
* If you receive 25% of Medicare payments
* If you see 20% of your Medicare patients through an
Advanced APM in 2017

20. www.careoptimize.com
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