The US Centers for Medicare and Medicaid Services, through their Innovation Center (CMMI) announced a new ACO program to go live in 2025 – ACO Primary Care Flex. The hope is to build on the data, experience, and successes they have had with their other models that promote primary care, but with a focus on rural and underserved regions.

Last week the Centers for Medicare & Medicaid Services (CMS) released a number of changes to the ACO Realizing Equity Access and Community Health (REACH) model. Changes aim to further advance health equity and increase participation in the payment model.

Over the last several weeks, we’ve focused on readiness for joining an Accountable Care Organization, or ACO. We’ve explored what an ACO is, shown how to see if your practice is ready to join an ACO, and shared five key questions to assess before either forming your own ACO or joining an existing ACO.

As we continue our series discussing Accountable Care Organizations, or ACOs, we now move from the topic of forming your own ACO to what are some key questions to ask before joining an existing ACO. Entering an existing ACO can be a lucrative and well aligned way to accomplish success in value based care for your MSSP patients, but you may find yourself facing buyers’ remorse if you don’t go in well-informed. If you do make a decision that doesn’t align with your practice’s priorities and goals, you will be locked into the model for at least one year, possibly more, depending on the terms of your agreement.

Over the last several weeks, we’ve been in a series discussing Accountable Care Organizations, or ACOs. We began this month by reviewing “What is an ACO and what do you need to know about them?”, and we continued last week by giving some tips to answer the question “Is your practice ready to join an ACO?”.

If you are a primary care practice, you’re most likely aware of the CMS directive to have all Medicare fee-for-service beneficiaries in an arrangement that includes accountability for quality and total cost of care by 2030. You’ve also most likely been approached within the last few weeks about joining an Accountable Care Organization (ACO), likely by multiple different groups, or you’ve done research and heard about ACOs recently. With Phase 1 of the ACO application period of May 18, 2023 through June 15, 2023 and Phase 2 July 11, 2023 through August 1, 2023, being aware of the deadlines is important, but even more important is being prepared to succeed in an ACO, and making the decision to even join one for the 2024 performance year.

If you are a primary care practice, you’ve likely been approached within the last few weeks about joining an Accountable Care Organization (ACO), possibly by multiple different groups. The reason for this flurry of activity is Phase 1 of the ACO application program goes from May 18 to June 15, 2023 and the final phase to add TINs to an ACO is July 11 to August 1, 2023. If you’re not already in an ACO, you’ll need to make some important decisions about whether or not to join an ACO for 2024, and which ACO to join. 

Quality measures are a key aspect of primary care, not just because value-based care requires satisfaction to receive incentive payments, but because they can impact patient wellness. At a base level, it is common sense to evaluate an individual for early signs of diseases that could evolve into a more serious issue such as cancer or heart disease. Unfortunately, not all insurance payors have the same idea of what quality measures should be tracked or even what the target values should be. For example, one payor may say hypertension is defined as having a blood pressure of greater than 130/80 while another may say 140/90. Uncontrolled diabetes may be defined as an A1C greater than 8 for one payor and greater than 9 for another. A lack of consistency in these expectations causes confusion for primary care practices and can result in unmet quality measures.