On Dec. 15, the Centers for Medicare & Medicaid Services (CMS) declared that it was initiating an ACO pilot program targeted at beneficiaries enrolled in both Medicare and Medicaid.
In accordance to CMS officials, the Medicare-Medicaid Accountable Care Organization model is created to permit Medicare Shared Savings ACOs to be accountable for the care, as well as Medicare and Medicaid costs, for dual eligibles.
The organization will partner with up to 6 states, with priority offered to states that have a low Medicare ACO saturation. The current Medicare ACOs mostly don’t have financial accountability for the Medicaid expenditures for dual eligibles strategy.
Medicare Shared Savings Program ACOs will be permitted by Medicare-Medicaid ACO Model to take on accountability for the quality of care and both Medicare and Medicaid costs for Medicare-Medicaid enrollees.
This is a new chance to influence and partner up with ACOs, director John Feore of Avalere said.
Feore said, “[The new ACO model] increases the desire of ACO to find the best PAC providers to work with, generally because Medicaid spending in few PAC settings is pretty high.”
“It heightens the focus on the PAC sector as a whole as it relates to the ACO world.”
Success can be found by the long-term care providers in the new model by demonstrating that “they are part of coordinated care … perhaps their beneficiaries have lower readmissions to the inpatient setting, entire sorts of measures that an ACO will be looking at closely as they are looking for PAC providers.”
Feore termed the program “nonpartisan delivery reform” and a “small-scale demo” whose existence wouldn’t be challenged and threatened by change-minded officials in the latest administration.