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James Michel
Senior Director, Medicare Research and Reimbursement

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ACO/Bundling

​Under the Affordable Care Act, long term care and post-acute care providers have new opportunities to partner with the Centers for Medicare & Medicaid Services (CMS) and other healthcare providers to coordinate patient care, improve patient quality care and lower healthcare costs.  Those options include:

  • Bundled Payments for Care Improvement: The Bundled Payments for Care Improvement initiative strives to improve patient care by fostering improved coordination through four broadly defined, patient-centered approaches. Three models involve a retrospective bundled payment arrangement, and one model would pay providers prospectively. Through the Bundled Payments initiative, providers have great flexibility in selecting conditions to bundle, developing the health care delivery structure and determining how payments will be allocated among participating providers.


  • Medicare Shared Savings Program for Accountable Care Organizations (ACOs): The Medicare Shared Savings Program will allow providers who voluntarily agree to work together to coordinate care for patients and who meet certain quality standards to share in any savings they achieve for the Medicare program.  ACOs which elect to become accountable for shared losses have the opportunity to share in greater savings. ACOs will coordinate and integrate Medicare services, with success being gauged by roughly 30 quality measures organized in four domains. These domains include patient experience, care coordination and patient safety, preventive health and at-risk populations. The higher the quality of care providers deliver, the more shared savings their Accountable Care Organization may earn, provided they also lower growth in health care expenditures. Click here to obtain more specific information on ACOs.


  • Advance Payment Accountable Care Organization Model: The Advanced Payment model will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program who also would benefit from additional start-up resources to build the necessary infrastructure, such as new staff or information technology systems. The advance payments would be recovered from shared savings achieved by the ACO.


  • Pioneer Accountable Care Organization Model: The Pioneer model is an initiative complementary to the Medicare Shared Savings Program designed for organizations with experience providing integrated care across settings.  The Pioneer Model tests a rapid transition to a population-based model of care, and engages other payers in moving toward outcomes-based contracts.  The initial group of Pioneer sites, slated to be announced later this year, will be positioned to rapidly demonstrate what can be achieved when we provide highly coordinated care to Medicare fee-for-service beneficiaries.


  • Financial Models to Support State Efforts to Integrate Care for Medicare-Medicaid Enrollees: A longstanding barrier to coordinating care for Medicare-Medicaid enrollees has been the financial misalignment between Medicare and Medicaid. This initiative will test two models– a capitated model and a managed fee-for-service model -- for States to better align the financing of the Medicare and Medicaid programs and integrate primary, acute, behavioral health and long term services and supports for Medicare-Medicaid enrollees. For those States that are interested in testing these two models, CMS is offering streamlined approaches and technical assistance to support necessary planning activities.
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