Cms Next Generation Aco Participation Agreement

Focus on Medicare providers/providers. “ACO Participants” – individuals or groups of Medicare providers/providers identified by a single Medicare Tax Identification Number (“TIN”) are the linchpins of the MSSP model. According to the MSSP model, an ACO can only be formed by one or more “ACO participants”. All suppliers or providers who bill for services to Medicare beneficiaries under a Medicare invoice number linked to the TIN of an ACO participant (for example. B all physicians in a group practice) must participate in an MSSP-ACO and be bound by the program`s participation requirements. While the rigidities of the MSSP`s engagement framework are valuable in determining accountability and oversight, they do not necessarily take into account the contributions of certain suppliers involved in coordinating the procurement of CCO recipients. More than 50% of Next Gen ACO patients must be covered by a results-based contract before the end of the first year of performance. CMS defines “outcome-based contracts” as such that include common savings and/or financial risks, patient experience assessments, and meaningful quality incentives. While Pioneer ACOS is already calling for results-based contractual initiatives, integrating outcome-based contractual requirements into the next-generation ACO model is part of a broader trend, in which Medicare is increasingly focusing on private cost-bearing agreements as an instrument to accelerate the introduction of new procurement and payment models. .

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