High-functioning rural Medicare ACOs: a qualitative review
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Rural policy brief
- Author(s):
- Vaughn, Thomas, author Mueller, Keith, author MacKinney, Clinton, author
- Contributor(s):
- RUPRI Center for Rural Health Policy Analysis, issuing body. Rural Health Research & Policy Centers, issuing body. Rural Policy Research Institute (U.S.), issuing body.
- Publication:
- Iowa City, IA : Rural Policy Research Institute, February 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Accountable Care Organizations Medicare Rural Health Services Rural Population United States
- Genre(s):
- Technical Report
- Abstract:
- An accountable care organization (ACO) is typically a group of physicians and/or hospitals that agree to form an independent entity for the purpose of providing high-quality health care to a group of attributed patients. If in doing so the ACO reduces the cost of care for the attributed patients to less than what was predicted, the payer shares a portion of those cost savings with the ACO. The Patient Protection and Affordable Care Act of 2010 (PPACA) established the Medicare Shared Savings Program (SSP), also known as the Medicare ACO program. In 2019, there were 559 Medicare ACOs serving more than 12.3 million attributed beneficiaries, and a total of 1,588 public and private ACO contracts, covering almost 44 million lives. Furthermore, multiple demonstrations supported by the Center for Medicare & Medicaid Innovation have tested various ACO innovation configurations, including the Advance Payment Model, the ACO Investment Model (AIM), the Pioneer ACO Model, and the Next Generation ACO Model. The Advance Payment Model and the AIM built on the existing SSP structure while the Pioneer and Next Generation ACO Models represented different configurations. This policy brief provides a qualitative review of success factor commonalities among four high-performing rural Medicare SSP ACOs. ACO success factors can inform ACO stakeholders and policy makers, and can facilitate additional ACO success strategy development--in both health care quality and cost reduction. Achieving success may be especially important because as of July 1,2019, the SSP changed from Track 1, Track 2, Track 3, and Track 1+ options to only two tracks--Basic (five levels) and Enhanced. In this new SSP "Pathways to Success," Levels A and B of the Basic Track allow time-limited one-sided risk (financial reward potential only). However, all Medicare SSP options will soon require two-sided risk (potential for reward and risk for penalty).
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (6 pages)).
- NLM Unique ID:
- 9918351084306676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918351084306676