New ACO designed to better serve dual eligibles strategy

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CMS’s Patrick Conway: Leveraging best ideas from states a goal.
CMS’s Patrick Conway: Leveraging best ideas from states a goal.

The Centers for Medicare & Medicaid Services announced Dec. 15 it was starting an ACO pilot program aimed at beneficiaries enrolled in both Medicare and Medicaid.

The Medicare-Medicaid Accountable Care Organization model is designed to allow Medicare Shared Savings ACOs to be accountable for the care, as well as Medicare and Medicaid costs, for dual eligibles, CMS officials said. 

The agency will partner with up to six states, with priority given to states that have a low Medicare ACO saturation.

Current Medicare ACOs often do not have financial accountability for the Medicaid expenditures for dual eligibles. 

The Medicare-Medicaid ACO Model will allow Medicare Shared Savings Program ACOs to take on accountability for the quality of care and both Medicare and Medicaid costs for Medicare-Medicaid enrollees.

This is a new opportunity to impress and partner up with ACOs, director John Feore of Avalere, told McKnight's.

“[The new model] enhances the ACOs' desire to find the best PAC providers to work with, simply because Medicaid spending in some PAC settings is pretty high,” Feore said. 

“It heightens the focus on the PAC sector as a whole as it relates to the ACO world.”

Long-term care providers can find success in the new model by showing that “they're part of coordinated care … perhaps their beneficiaries have lower readmissions to the inpatient setting, all sorts of measures that an ACO will be looking at closely as they're looking for PAC providers.”

Feore called the program “nonpartisan delivery reform” and a “small-scale demo” whose existence would not likely be threatened by change-minded officials in the new administration.