Accountable Care Organization Reimbursement and Gain Sharing includes the agreed-upon approach to paying the ACO and its participating providers for health care services rendered and bearing risk as well as the approach to allocating revenues and bottom-line gains to participating stakeholders.
The Center for Medicare and Medicaid Innovation has announced a new “Pioneer ACO” program, available to provider organizations that are already experienced in population management and bearing risk for performance and cost. The new program has a three year term, with the first 2 years offering a higher level of risk/gain-sharing than is permitted under
In a May 11th letter to CMS Administrator, Dr. Don Berwick, the American Medical Group Association (AMGA) President, Don Fisher, complained that the draft regs for the Medicare Shared Savings Programs were “overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve to make this voluntary program attractive.” In particular, Fisher mentioned concerns
The transformation of our health care system requires many different people to change their behaviors. Leaders of health care organizations have to be willing to make investments that they have historically not been willing to make. Physicians have to change the way they relate to patients, the way they interact with their non-physician team members
How does behavioral economics and “gamification” relate to ACOs? Read More »
After much delay, the Federal Government has finally released the following: 427 page “notice of proposed rule-making” from CMS covering Accountable Care Organizations (ACO) and the associated Medicare Shared Savings Program 26 page document regarding the “waiver designs” for the Shared Savings programs and the Innovation Center A short “perspective” piece in the New England
Links to CMS ACO Proposed Rules and Dr. Berwick’s associated NEJM comments Read More »
On March 23, 2011, Trent Haywood, MD, JD, and Keith Kosel, PhD, MBA published the results in the New England Journal of Medicine (NEJM) web site of a financial model of a hypothetical Accountable Care Organization (ACO). This model shows that ACOs are likely to lose money on the Medicare Shared Savings Program called for in
This is probably the single most useful reference regarding Accountable Care Organizations, outlining alternative ways of conceptualizing them and giving a balanced explanation of the pros and cons of alternative models, including structure and reimbursement. David Share, MD, from BCBSM was involved, and the document uses BCBSM’s Physician Group Incentive Program as a case study.
Harold Miller’s Paper: How to Create Accountable Care Organizations Read More »
