CMS Launches New Medicare–Medicaid Shared Savings ACO Model
The Centers for Medicare and Medicaid Services recently announced a new accountable care organization (ACO) aimed at improving care and lowering costs by allowing beneficiaries enrolled in both Medicare and Medicaid to be covered under Medicare Shared Savings Program ACO.
“This model aims to provide improved care coordination for those enrolled in both Medicare and Medicaid, allowing providers to focus more on providing care for their patients rather than administrative work,” Patrick Conway, MD, acting principal deputy administrator at the CMS, said in a press release. “CMS continues to partner with and leverage the best ideas from states to transform our health care system to improve quality and care coordination. In the long run, this partnership will result in healthier people and smarter spending.”
The current Medicare ACO initiatives attribute beneficiaries who are Medicare-Medicaid enrollees to ACOs; however, according to CMS, Medicare ACOs often do not have financial accountability for the Medicaid expenditures of those beneficiaries. The new model allows Medicare Shared Savings Program ACOs to take on accountability for the quality of care and the Medicare and Medicaid costs for enrollees.
CMS is now accepting letters of intent from states that wish to work alongside CMS to design specific elements that are unique to each state within the new model. CMS opened up the Medicare-Medicaid ACO Model to all states and the District of Columbia that have a sufficient number of Medicare and Medicaid patients in fee-for-service programs. Initially, CMS will enter into participation agreements with up to six states with a preference given to states with a low saturation of Medicare ACOs. After a state is approved to participate in the new model, CMS will release an application to ACOs and health care providers within the state.
The new model is already receiving praise from industy leaders who are hoping to strengthen care coordination among providers while containing costs and improving outcomes for patients enrolled in Medicare and Medicaid.
—Julie Mazurkiewicz
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