Presentation is loading. Please wait.

Presentation is loading. Please wait.

Next Generation ACO Models: Legal and Operational Design Strategies

Similar presentations


Presentation on theme: "Next Generation ACO Models: Legal and Operational Design Strategies"— Presentation transcript:

1 Next Generation ACO Models: Legal and Operational Design Strategies
Friday, May 27, 2016, H20 Session (11:15-12:15 pm) Thomas N. Shorter, JD, FACHE Godfrey & Kahn, S.C. Madison, WI

2 Outline The CMS Next Gen ACO Model I. Core Principles II. Scope
III. Legal Components IV. Operational Design Elements

3 I. Core Principles Protect Original Medicare beneficiaries’ freedom of choice Engage beneficiaries in their care through benefit enhancements Create long-term financial sustainability

4 I. Core Principles (cont’d)
Utilize prospectively-set benchmarks Reward quality; Reward improvement and attainment of efficiency; and Transition away from an ACO’s recent expenditures when setting and updating the benchmark.

5 I. Core Principles (cont’d)
Mitigate fluctuations in aligned beneficiary populations Smooth cash flow by seeking alternative payment mechanisms Incentivize greater coordination of care

6 Comprehensive ESRD Care
II. Scope Two-sided risk model Next Gen 21 participants: 7 from MSSP and 8 from the Pioneer Model 2 WI - based participants: Bellin Health DBA/Physician Partners and ThedaCare ACO Comprehensive ESRD Care Oncology Care Model

7 III. Legal Components Legal Entity requirements
Governing Body structure, responsibilities, composition and control requirements Leadership and Management requirements

8 IV. Operational Design Elements
Benchmark B. Risk Arrangements Increased Shared Risk 80% sharing rate (PY1-3) 85% sharing rate (PY4-5) 15% savings/losses cap Discount Full Performance Risk (100% Risk)

9 IV. Operational Design Elements
Payment Mechanisms 1. Normal FFS Payment 2. Infrastructure Payments 3. Population Based Payments 4. Capitation Conceptual

10 Infrastructure Payments Conceptual Diagram
All Other Medicare Providers CMS Next Generation Affiliates Next Generation Preferred Providers Next Generation Providers/Suppliers ACO Claim Claim Payment Per-beneficiary per- month

11 IV. Operational Design Elements
D. Beneficiary Eligibility and Alignment Benefit Enhancement F. Quality and Performance G. Monitoring and Oversight

12 V. Conclusion: Future Development
A. Evaluation B. Application Scoring & Selection C. Duration of Agreement(s) 1. Three performance periods for 2016 2. Two performance periods for 2017

13 Thank You Thomas N. Shorter, JD, FACHE Godfrey & Kahn, S.C. One East Main Street, Suite 500 Madison WI (608)


Download ppt "Next Generation ACO Models: Legal and Operational Design Strategies"

Similar presentations


Ads by Google