Medicare and ACOs Models . CEO Call January 12, 2012. Pioneer ACOS.
January 12, 2012
“ For established organizations with a track record of providing robust coordinated care, the CMS innovation center is offering a pioneer ACO program designed to encourage and support the next wave of innovation from vanguard organizations.”
Don Berwick, Nov. 2011
(80 applications, 32 selected)
A beneficiary aligned to an ACO maintains complete freedom to visit any healthcare provider accepting Medicare, just as all Medicare beneficiaries participating in original, fee-for-service Medicare do. These beneficiaries do not need a referral to see a specialist outside the ACO. Unlike a managed care arrangement, like an HMO or a Medicare Advantage plan, a beneficiary aligned to an ACO is free to see any healthcare provider accepting Medicare at any time. In addition, beneficiaries maintain all the benefits to which they are entitled in original, fee-for-service Medicare.
Health Affairs, Dec 2011
In Year 1, CMS will pay for ACOs that report on all 33 measures. Year 2, CMS will pay for performance in 25 of the measurement categories and reporting in 8 measurement areas. In Year 3, CMS will pay for performance in 32 measurement categories while only requiring ACOs to report on CAPHS Health Status/Functional Status.