Overview

Accountable care and other alternative payment initiatives in both the public and private sector have continued to grow over the past several years, adding to the experience and evidence on what is working and ways to continue evolving accountable care models. The Eighth National Alternative Payment Model (APM) and Accountable Care Organization (ACO) Summit (www. ACOSummit.com) will provide an unprecedented opportunity to discuss remaining barriers to widespread ACO and APM implementation, strategies to overcome them, and policies to encourage the continued growth and sustainability of the accountable care movement. The Summit brings together leading policymakers, experts, and APM implementers to provide unique and in-depth insights on APM implementation and ongoing health care reform. The Summit will cover a variety of topics including innovative contract and payment arrangements, the impacts of consolidation on value-based care, management of high-risk patients, using technology to improve patient care, integrating community-bases services, and remaining barriers to effective data interoperability. The Summit will also be a great opportunity to explore the future of accountable care and other alternative payment model contracting, practice, and policies, including the broader impact of the Medicare Access and CHIP Reauthorization Act (MACRA), which encourages the adoption of APMs.

WHAT ARE APMs AND ACOs?

An alternative payment model (APM) is a payment approach that rewards providers for delivering high-quality and cost-efficient care through financial incentives and penalties based on performance. ACOs, the most widely used APM, are groups of physicians, hospitals, and other providers that receive financial rewards for achieving patient-focused quality targets and demonstrating reductions in overall spending growth for their defined patient population. ACOs can be organized in a number of ways, ranging from fully integrated delivery systems to networked models within which physicians in small office practices can work together to improve quality, coordinate care, and reduce costs. ACOs can also feature different payment incentives, ranging from “one-sided” shared savings within a fee-for-service environment to a range of capitation arrangements with quality bonuses. In addition, ACOs are compatible with a range of other payment reforms, such as medical homes and bundled payments; they can help assure that these reforms lead to sustainable quality improvements and cost reductions. In sum, ACOs provide an ideal mechanism to transition from paying for volume and intensity to paying for value.

HOW IS ACO AND APM IMPLEMENTATION PROCEEDING ACROSS THE COUNTRY?

As of January 2017, over 450 organizations across the country are participating in the Medicare Shared Savings Program (MSSP), which aims to promote accountability for the care of Medicare fee for service (FFS) beneficiaries, coordinate care for all services provided under Medicare FFS, and encourages investment in infrastructure and redesign care processes. In January, over 20 organizations joined the Next Generation ACO Model, which provides greater financial risk and reward, in exchange for even more payment and regulatory flexibility to facilitate better coordination of care. Next year, CMS will launch a MSSP Track 1+ option to help ease organizations into two-sided risk with lower overall financial risk coupled with some of the flexibility afforded to other two-sided risk participants. In addition, the Quality Payment Program (QPP), created by MACRA, launched in January and creates additional incentives for physicians to provide care to Medicare patients through alternative payment models such as ACOs and bundled payments. Additional APMs are likely to be developed and/or approved by CMS in the coming years to provide more opportunities for providers to participate in alternative payment arrangements.

Beyond Medicare initiatives, interest and participation in accountable care and other alternative payment reforms has been growing both in states and in the private sector. More than ten states have developed programs to support the transition to accountable care-like models for either their Medicaid programs or state employees. There are now over 400 private sector ACOs with all of the major private health plans implementing value-based care initiatives; these payment reforms include accountability for the full continuum of patients’ care, payment contingent upon improving the quality and coordination of care, and responsibility for cost management within a target budget. In tandem with the Medicare Shared Savings Program, the Next Generation ACO Model, and other Medicare APMs, these private sector efforts will be instrumental in moving accountable care implementation forward as health care reform progresses.

WHO SHOULD ATTEND