Pioneers! Oh Pioneers! ACO Demonstrations: Pioneer and Advance Payment Models

Last week CMS announced a new ACO demonstration to be run through the Center for Medicare and Medicaid Innovation (Innovation Center). Through three different programs, the Innovation Center will work with providers to lead them through the implementation process for establishing an ACO. The demonstration will be run concurrently with the Shared Savings Program that was created by health reform. CMS released rules governing that program in late March which will also be applicable to ACOs that are established through the demonstration.

States Making Changes to Medicaid: User Fees and Expansion Among Proposals

Earlier this month, the Florida Legislature passed legislation overhauling the Medicaid program. In addition to increasing oversight of managed care plans and requiring plans to return a portion of profits in excess of five percent, the initiative eliminates the traditional fee-for-service (FFS) option for most recipients. The reform also mandates enrollment in long-term managed care programs for seniors.

Major Clinic Takes Wait and See Approach to ACOs: Industry Abuzz with Meaning of Decision

Since 2005, CMS has been running a Physician Group Practice Demonstration (PGP) that operates similar to an Accountable Care Organization (ACO).  Under the Demonstration, PGPs were responsible for providing integrated, coordinated care to a specified Medicare FFS population, which has provided the framework for the rules governing the Shared Savings Program.  Under the Demonstration, PGPs increased quality of care for patients and six of the ten PGPs shared in $46 million in savings over three years.