Next Generation ACO

For organizations experienced in population health, the Medicare Next Generation ACO model offers greater opportunities for financial risk and reward. Participants can use payments for incentives, infrastructure, and revenue-sharing.

Here are two examples.

UnityPoint Health: Next Gen as a Logical Next Step

MACRA and the promise of 105 million patients by 2020 drew UnityPoint Health to the ACO model, Aric Sharp, vice president of Unity Point Accountable Care, told attendees at AMGA’s annual conference. After Pioneer ACO and MSSP participation, a number of other factors led the organization specifically to the Next Gen model, including:

  • Prospective, rather than retroactive, patient attribution
  • 80% risk sharing
  • Waivers in areas like skilled nursing, telehealth, and home visits
  • The opportunity to collaborate with peers and the Center for Medicare and Medicaid Innovation (CMMI) as the ACO model evolves

UnityPoint Health had 84,000 lives in its Next Gen ACO and $1 billion in medical spend in agreements with downside risk. To guide its clinical transformation, it created its own trademarked care model. This model is grounded in five foundational processes (common care plans, clinical care pathways, care transitions, and utilization and referral management) and guides the use of analytics, risk stratification, platforms, and services across the organization.

For success in the Next Gen ACO model, Sharp advised:

  • Spreading risk out over a sufficient volume of lives, and keeping care within network to better manage costs
  • Prioritizing physician training and coaching to manage change and reduce outliers and variations in care
  • Focusing on risk coding, and on favorable and fair contract terms. “Work on sharing risk with your network partners in amounts that are both meaningful and palatable.”

UnityPoint Health’s Care Model

Trinity Health: Making the Right Thing the Easiest Thing

When sharing Next Gen ACO success stories at a recent AMGA conference, Barbara Walters, executive vice president and chief population officer of Trinity Health, relayed the story of Rodney, a 54-year-old patient. Before care through the ACO program, Rodney visited the ER 80 times over a 10-month period for pain, numbness, nausea, and stroke-like symptoms.

Then a care manager met with Rodney. Discovering behavioral health and socioeconomic components to Rodney’s illnesses, the care manager referred him to specialists in behavioral health and pain management, as well as medical services. This helped him achieve compliance with his appointments and medications and gain coping mechanisms for his anxiety disorder. After these interventions, Rodney only visited the ER twice over a two-month period.

Trinity Health, a 22-state diversified network, began its three-year Next-Gen ACO journey in 2016 as a move to replace its Medicare Shared Savings Program with an enhanced model similar to Medicare Advantage. The organization set up Trinity Health ACO (THACO) as a separate legal entity, working through five participating organizations that it refers to as “chapters.”

The Next Gen ACO model aligns with Trinity Health’s mission, “making the right thing to do the easiest thing to do,” Walters said. The Next Gen ACO model removes the perverse incentives and limitations of the fee-for-service world by refocusing care teams on the patient’s needs at and away from the visit.

Trinity Health: Collaborative Model

 

Next Gen ACO Lessons Learned

Given the variety of Medicare beneficiaries in THACO’s attributed population, success has depended on its five chapters working together to:

  • Understand aligned beneficiaries and their clinical conditions
  • Implement resources for care management
  • Use data and analytics to understand and measure performance, then share best practices in population health
  • Document care for chronic conditions
  • Engage beneficiaries and providers
  • Proactively manage the use and total cost of care
 

AMGA: Your Partner for Value-Based Care. Contact Bill Baron, 703.838.0033 ext. 336 to take the next step.

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