New ACO model aims to improve care, lower costs for dual eligibles

The Centers for Medicare & Medicaid Services on Thursday announced a new accountable care organization model aimed at improving care quality and lowering costs for 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. Currently Medicare ACOs do not have financial accountability for Medicaid expenditures for beneficiaries enrolled in both programs.

A fresh focus on Medicaid expenditures gives post-acute care providers a new opportunity to impress and partner up with ACOs, John Feore, director with 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.”

CMS is currently accepting letters from states wishing to work with the agency on the model; it will then partner with up to six states, with priority given to states that have a low Medicare ACO saturation.

The program is unlikely to find itself in jeopardy in 35 days when President-elect Donald Trump takes office, despite uncertainty surrounding his administration's healthcare policies, Feore added.

“It's generally a nonpartisan delivery reform … targeted toward the higher-cost beneficiaries,” Feore said. “It's a small scale demo, and it won't be mandatory, it just builds on an existing program. I don't think this is something that is going to be on the chopping block in the first 100 days.”