decisionhealth Newsletters, Part B News - 2015 Issue 3 (March)
‘Next Generation’ ACO model speeds up P4P transition — and your need to adapt
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Article Overview
This piece reviews CMS’s Next Generation ACO model and places it in the context of Medicare’s evolving payment landscape. It is aimed at providers, administrators, and coding/reimbursement professionals who need to understand how ACO structures, participation requirements, patient engagement features, waivers, and alternative payment approaches may affect care delivery and operations. The article also compares the model with other CMS initiatives and discusses why the trend matters even for organizations not participating directly.
Why This Topic Matters
Medicare payment policy is moving toward greater risk sharing and performance-based incentives. Understanding this model helps healthcare organizations anticipate operational, clinical, and reimbursement changes tied to ACO participation and related CMS initiatives.
Article Sections
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Accountable care organizations
Introduces the Next Generation ACO model and frames it within CMS’s broader shift toward performance-based payment. The section also compares the model conceptually with other ACO structures.
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Requirements for patients in new ACOs
Summarizes participation and patient-alignment topics for the new model, including eligibility expectations, patient engagement, and beneficiary-related features.
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Also: waivers, capitation
Covers payment structure options and waiver-related features associated with the model. This section also notes how the approach differs from standard Medicare restrictions.
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How ACO model affects even those not in it
Discusses broader implications of the model for providers outside the program and positions it within the transition to alternative payment methods. The section mentions other CMS initiatives as related stepping-stones.
What You Will Learn
- How CMS’s Next Generation ACO model fits into the shift toward pay-for-performance
- What general participation and patient-alignment themes the model emphasizes
- How the model relates to payment flexibility, waivers, and capitation concepts
- Why providers outside the model may still need to prepare for similar payment changes
- How the model compares with other CMS alternative payment initiatives
Who Should Read This
- Physicians and physician groups
- ACO administrators
- Hospital and health system leaders
- Medical billing and reimbursement professionals
- Healthcare compliance and operations staff
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