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CMS Shared Saving Program launches with 27 ACOs

May 26, 2012

A new program that will help physicians, hospitals, and other health care providers work together to improve care for people with Medicare is off to a strong start, according to the U.S. Centers for Medicare & Medicaid Services (CMS).

Under the new Medicare Shared Savings Program, 27 Accountable Care Organizations (ACOs) have entered into agreements with the CMS, taking responsibility for the quality of care furnished to people with Medicare in return for the opportunity to share in savings realized through improved care.

The Shared Savings Program and other initiatives related to Accountable Care Organizations are made possible by the Affordable Care Act, the health care law of 2010. Participation in an ACO is purely voluntary for providers and beneficiaries and people with Medicare retain their current ability to seek treatment from any provider they wish.

The first 27 Shared Savings Program ACOs will serve an estimated 375,000 beneficiaries in 18 states. That brings the total number of organizations participating Medicare shared savings initiatives on April 1 to 65, including the 32 Pioneer Model ACOs that were announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. In all, as of April 1, more than 1.1 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives.

“We are encouraged by this strong start and confident that by the end of this year, we will have a robust program in place, benefitting millions of seniors and people with disabilities across the country,” said CMS Acting Administrator Marilyn Tavenner.

“Anyone who has multiple doctors may have experienced the frustration of fragmented and disconnected care: lost or unavailable medical charts, trouble scheduling an appointment or talking to a doctor, duplicated medical procedures, or having to share the same information over and over with different doctors,” CMS officials noted in a written statement on the program last month. “Accountable Care Organizations are designed to lift this burden from patients, while improving care and reducing costs.”

The Shared Savings Program was created by the Affordable Care Act after a number of efforts in the private sector showed that improving care can lead to lower costs.

The selected ACOs include more than 10,000 physicians, 10 hospitals, and 13 smaller physician-driven organizations in both urban and rural areas. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving.

The CMS is reviewing more than 150 applications from ACOs seeking to enter the program in July.

To ensure that savings are achieved through improving and providing care that is appropriate, safe, and timely, an ACO must meet strict quality standards. For 2012, the CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care.

The CMS also announced that five ACOs are participating in the Advance Payment ACO Model program that began April 1.

“This model will provide advance payment of expected shared savings to rural and physician-based ACOs participating in the Shared Savings Program that would benefit from additional start-up resources. These resources will help build the necessary care coordination infrastructure necessary to improve patient outcomes and reduce costs, such as new staff or information technology systems,” according to the CMS statement.

The CMS is reviewing more than 50 applications for Advance Payments that start in July.

Additional information can be found on the CMS website ACO page (http://innovations.cms.gov/initiatives/ACO/).

Additional information on the ACOs announced last month can be found in the fact sheets accessible on the CMS website media page (http://www.cms.gov/apps/media).

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