The Centers for Medicare and Medicaid Services (CMS) recently announced a new initiative designed to improve the quality of care and lower costs for beneficiaries who are enrolled in both Medicare and Medicaid.
The Medicare-Medicaid Accountable Care Organization (ACO) Model builds on the current Medicare Shared Savings Program (MSSP) and advances efforts to partner with states in transforming the health care delivery system.
In current Medicare ACO initiatives, beneficiaries who are Medicare-Medicaid enrollees may be attributed to ACOs. However, Medicare ACOs often do not have financial accountability for the Medicaid expenditures for those beneficiaries. 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.
CMS is accepting letters of intent from states that wish to work with CMS to design certain state-specific elements of the model. The Medicare-Medicaid ACO Model is open to all states and the District of Columbia that have a sufficient number of Medicare-Medicaid enrollees in fee-for-service Medicare and Medicaid. CMS will enter into participation agreements with up to six states with preference given to states with low Medicare ACO saturation. Once a state is approved to participate in the model, a request for application will be released to ACOs and health care providers in that state.
The MSSP and other ACO initiatives were created to change the incentives for how medical care is delivered and paid for in the United States, moving away from a system that rewards the quantity of services to one that rewards the quality of health outcomes. The North Carolina Medical Society (NCMS) has supported practices pursuing these innovative models of care through its Population Health Collaborative and its MSSP and Next Gen Council. For more information about the NCMS’ role in the move toward value-based payment models, contact Melanie Phelps via email at [email protected].