If you are part of an ACO or a clinically integrated network (CIN), you have begun the value-based care journey. As payment models continue to change, the question of how and when to increase appropriate risk and reward requires careful consideration. With the release of the final rule for Pathways to Success, CMS is increasingly pushing ACOs toward two-sided risk, and most commercial payers aren’t far behind.
The success of the 2017 Next Generation ACO Model, a CMS initiative that provides experienced ACOs with a higher level of reward for taking on higher levels of financial risk, is strong evidence that ACOs with more at stake financially generate more savings. According to a Health Affairs blog post published last year, in just the second year of the program’s existence, the 2017 cohort of Next Generation ACOs generated $164 million in savings, an average of $3.7 million per ACO. In comparison, Medicare Shared Savings Plan ACOs achieved a net savings of $314 million during the same time period, but that works out to just an average of $668,000 per ACO.