CMS wants to know if upfront funds would be carrot enough to attract ACO participation

May 27, 2011

CMS wants to know if upfront funds would be carrot enough to attract ACO participation

Would physician practices be more likely to agree to participate in Accountable Care Organizations (ACOs) if they had some upfront funds-the carrot-to allay the significant expenses-the stick? The Centers for Medicare and Medicaid Services (CMS) is trying to find out.

Responding to criticism that many providers will lack the access to capital required to start up an ACO, CMS has asked for comments on a proposal to offer advances on future shared savings. As proposed, ACOs would receive a monthly advance based on patient count. Comments on the plan are due here by June 17.

In addition, CMS is looking to mature ACOs to lead the way in effectively coordinating care and reducing costs by participating in the Pioneer ACO Model announced on May 17.

“The Pioneer model is an opportunity for those organizations that have already adopted significant care coordination processes to move further and faster into seamless, coordinated care by using alternative payment mechanisms,” says Richard Gilfillan, MD, director of the new Center for Medicare and Medicaid Innovation.

The Pioneer model features 2 years of higher levels of shared savings and shared risk for participating organizations, followed by population-based payments in year 3, in a separate track from the shared savings program. The program also will work with other payers to reduce costs and improve the quality of healthcare for individuals with private insurance. Interested organizations have until June 10 to submit letters of intent to participate in the program.