Vermont Releases RFP for Next Generation Accountable Care Organization
CMS defines Medicare ACOs as: comprised of groups of doctors, hospitals, and other health care providers and suppliers who come together voluntarily to provide coordinated, high-quality care at lower costs to their Original Medicare patients. ACOs are patient-centered organizations where the patient and providers are true partners in care decisions. Medicare beneficiaries will have better control over their health care, and providers will have better information about their patients’ medical history and better relationships with patients’ other providers. Provider participation in ACOs is purely voluntary, and participating patients will see no change in their Original Medicare benefits and will keep their freedom to see any Medicare provider. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.
CMS further describes the Next Generation ACO Model as an initiative for ACOs that are experienced in coordinating care for populations of patients. It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP). The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.
According to the article, “although Vermont’s Next Gen ACO is structured similarly to the Center for Medicare and Medicaid Services’ (CMS) Next Generation ACO Model (Next Gen) that serves Medicare beneficiaries, Vermont’s new ACO approach is attempting to go beyond its Medicare-inspired counterpart to make providers even more accountable for cost and patient outcomes.”
“Vermont’s Medicaid environment is uniquely suited for this transformative payment experiment. Instead of purchasing health care services through a managed care contractor, the Department of Vermont Health Access (DVHA) operates a public Medicaid managed care model. This gives Vermont direct access to its providers, with whom it has established solid relationships. With roughly 190,000 Medicaid enrollees, the population is small enough to allow the state to closely monitor quality outcomes.”