The Centers for Medicare and Medicaid Services (CMS), Center for Medicare and Medicaid Innovation, recently released a request for applications seeking accountable care organizations (ACOs) to engage in a higher risk, higher reward arrangement than is currently available to ACOs participating in other CMS initiatives. The Next Generation ACO Model will test whether strong financial incentives for ACOs can improve health outcomes and reduce expenditures for Medicare fee-for-service beneficiaries. ACOs participating in the model are encouraged to develop relationships with individuals and entities that provide services to Medicare beneficiaries aligned with the ACO to develop methods of efficiently delivering quality health care services.
To be able to participate in the Next Generation ACO model, an ACO must be formed by eligible Medicare-enrolled providers and suppliers (including physicians and other practitioners, physician networks, and hospitals), meet certain governing body and leadership requirements, operate under outcomes-based contracts, and have at least 10,000 Medicare beneficiaries assigned to the ACO. Outcomes-based contracts include any third-party payor contract that includes financial accountability, patient experience evaluations, and/or substantial quality performance incentives. Many of the participation requirements mirror the requirements for ACOs participating in the Medicare Shared Savings Program (MSSP).
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