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Nina Marshall

, National Council for Behavioral Health

CMS: Accountable Care Organization Regulations Up for Review

October 30, 2014 | Integrated Care | Comments
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The Centers for Medicare and Medicaid Services (CMS) has indicated that we’ll likely be ringing in the New Year with revised regulations for Accountable Care Organizations in the Medicare Shared Savings Program.

Signals from CMS indicate that the revised rules will address stakeholder feedback on how patients are attributed to individual ACOs – an important issue because it affects the ACO’s risk pool and its potential shared savings. Currently, beneficiaries are attributed retrospectively based on primary care usage; networks don’t know in advance what their patient group is going to look like, and they don’t know how it will change year to year. Unless there’s a complete overhaul of the ACO model and patients are locked into a network – which is highly unlikely – we can expect renewed attention on patient engagement strategies and increased insularity amongst provider networks. My advice: get in early. Need to know how? Start here and here.

ACOs have had their share of critics, but in the latest rounds of reporting out of CMS, 64 of the 243 Medicare ACOs that launched in 2012 have saved enough to earn bonuses. Those ACOs are meeting initial quality benchmarks and saving the Medicare system money.

At the same time, the number of “Pioneer” ACOs – those that had the most aggressive shared savings design and included networks that were already well established and considered ahead of the curve in population management – has dropped from 32 to 22 participants.

In other words, the exact design and calibration of requirements for ACOs are still evolving, but in 2015 and beyond we can only expect to see more movement in the direction of large-scale integrated systems – and behavioral health providers need to get on the board.