Reimbursement

Medicare Accountable Care Organizations

According to the Centers for Medicare & Medicaid Services (CMS), 561 accountable care organizations (ACOs) participated in the Medicare Shared Savings program in 2018, covering some 10.5 million beneficiaries. Shared Savings ACOs receive a portion of potential financial savings if they meet quality and cost benchmarks, but also must eventually share in potential losses.

 

 

CMS says that 58 ACOs participated in 2018 in the Next Generation ACO program, which gives participants the opportunity to share in an even higher percent of potential losses, in exchange for a greater portion of potential financial savings.

 

USA ACO Map

Type of ACO

Description

More Details

Number of ACOs

Shared Savings
Providers share in financial savings if they meet quality and cost benchmarks. Providers can also choose to share in losses in exchange for a higher percentage of shared savings.
ACOs can select from a variety of payment tracks. ACOs formed before 2019, can choose to share only in savings—thus avoiding sharing in losses—for six years. Those formed or renewed in 2019 or after are allowed to share in savings-only for two years before they are required to share in the risk of financial losses.
Pioneer

Providers share in a greater percentage of financial savings than Shared Savings ACOs, but also a greater percentage of financial losses. 

 

The Pioneer ACO program concluded in 2016. Many Pioneer ACOs transitioned to Shared Savings or Next Generation ACOs during the course of the Pioneer program.
9 Pioneer ACOs in 2016
Next Generation
Providers can take on even greater financial risk than Pioneer ACOs, including total financial risk for providing care for a specific population.
The program is structured to set more predictable financial targets for ACOs, and to allow greater flexibility in care management and patient engagement. Such ACOs have greater availability of telehealth and post-discharge home visit services
Comprehensive End-Stage Renal Disease Care Model (CEC)
Dialysis facilities, nephrologists, and other kidney care professionals provide coordinated care for ESRD patients.

Large dialysis organizations (those with 200+ facilities) are eligible for shared savings payments, but also are liable for shared losses. They also share in greater levels of risk than their smaller counterparts. 

 

Small dialysis organizations (those with fewer than 200 facilities) are eligible to receive shared savings payments, but are not liable for shared losses. In 2017, they were given the option of assuming downside financial risk, accompanied by the opportunity for greater shared savings.