All but two of 39 accountable care organizations reporting outcomes in the Next Generation ACO model earned shared savings rather than owed money, a figure the National Association of ACOs touts as a success for value-based, capitated payments. 

Next Generation is Medicare’s model of greatest risk. NAACOS wants to see the four-year model made permanent.

Collectively, Next Gen ACOs saved Medicare $559 million last year, according to partial 2019 performance data made available by the Centers for Medicare and Medicaid Services.

WHY THIS MATTERS

ACOs are accountable for the cost and quality of beneficiary care. They earn the right to share with Medicare savings generated if certain spending and quality metrics are met. 

ACOs hit an average quality score of 93.7% out of a perfect score of 100, improving care for 1.2 million seniors, according to NAACOS. 

After accounting for shared savings paid to ACOs for holding down costs and hitting quality targets as well as shared losses and discounts paid to the government, the Next Gen program netted $204 million to Medicare in 2019. By comparison, Next Gen ACOs saved Medicare $406 million in 2018 and netted $185 million after shared savings and losses.

THE LARGER TREND

Launched in 2016, and extended by a year to end at the end of 2021, Next Gen builds off former innovation models, such as Pioneer, which started in 2012. CMS extended the program due to the COVID-19 pandemic.

ON THE RECORD

“For every year of the program, Next Gen ACOs yielded savings for Medicare money while also showing an improvement in quality. Very few programs CMS has developed over the years can say that,” said Clif Gaus, president and CEO of the National Association of ACOs. “NAACOS continues to call on CMS to make the Next Gen model a permanent fixture in Medicare, either as a stand-alone program or an option within the Shared Savings Program.”
 

ACO Name Total Aligned Beneficiaries Total Benchmark Expenditures Total Actual Expenditures for Aligned Beneficiaries Earned Shared Savings Payments/Owe Shared Losses
Steward Integrated Care Network, Inc. 116,246 $1,544,646,145 $1,522,698,357 $17,207,066
ThedaCare ACO, LLC 15,874 $144,559,315 $143,365,443 $935,996
Pioneer Valley Accountable Care, LLC 44,201 $520,627,651 $514,213,418 $5,028,759
CHESS NEXTGEN LLC 29,367 $337,266,985 $327,680,918 $9,394,345
Accountable Care Coalition of Southeast Texas, Inc 17,389 $236,869,357 $219,148,172 $17,366,762
Trinity Health ACO, Inc. 77,901 $941,696,538 $910,594,340 $24,384,123
Henry Ford Physicians Accountable Care Organization, LLC 26,572 $359,326,038 $352,466,223 $5,378,095
Deaconess Care Integration, LLC 39,968 $439,346,234 $427,837,229 $9,023,060
Park Nicollet Clinic 14,229 $150,026,494 $147,574,093 $1,922,682
UnityPoint Accountable Care L.C. 100,200 $1,071,112,979 $1,016,449,896 $41,987,629
Physician Partners LTD. 12,403 $122,716,225 $119,682,569 $2,378,386
Triad HealthCare Network, L.L.C. 28,801 $300,956,244 $291,697,913 $9,073,165
Atrius Health, Inc. 39,354 $471,519,011 $452,676,439 $18,465,721
HCP California, LLC 30,217 $423,063,832 $435,448,822 ($9,907,993)
NW Momentum Health Partners ACO, LLC 13,787 $131,396,899 $129,738,056 $1,300,533
UT Southwestern Accountable Care Network 94,625 $1,239,092,055 $1,187,431,915 $50,626,938
Accountable Care Options, LLC 10,952 $150,604,322 $149,668,641 $916,968
St. Luke’s Clinic Coordinated Care, LTD 32,489 $346,525,684 $317,278,019 $22,930,169
ProHealth Solutions, LLC 15,809 $163,214,109 $158,499,385 $3,696,343
Indiana University Health 63,692 $753,934,320 $711,353,369 $29,554,225
Carilion Clinic Medicare Shared Savings Company, LLC 52,775 $536,490,623 $510,506,034 $20,371,918
Arizona Care Network, LLC 35,751 $399,075,814 $397,495,209 $1,239,195
APA ACO, Inc. 30,740 $504,936,872 $467,646,269 $19,793,525
UNC Senior Alliance, LLC 30,357 $316,423,039 $301,828,764 $14,302,389
UW Health ACO, Inc. 27,498 $267,722,517 $256,244,488 $8,998,775
Reliant Medical Group, Inc 10,851 $140,684,947 $130,546,703 $9,935,480
Reliance Next Gen ACO, LLC 12,668 $169,196,334 $158,615,389 $8,295,461
Primary Care Alliance 13,011 $163,293,662 $142,200,984 $20,670,824
Revere Health 15,399 $176,343,855 $171,698,950 $3,641,606
CoxHealth Accountable Care, LLC 19,531 $183,521,482 $184,852,277 ($1,064,636)
Franciscan Missionaries of Our Lady Health System Clinical Network, LLC 25,270 $280,978,730 $260,736,786 $16,521,549
CareMount ACO 24,664 $305,582,388 $291,043,463 $11,398,517
Primaria ACO, LLC 28,656 $336,591,843 $313,302,980 $22,823,085
Best Care Collaborative 14,795 $176,349,676 $168,947,631 $7,254,004
Accountable Care Coalition of Tennessee, LLC 22,489 $221,941,879 $205,764,102 $15,854,222
Torrance Memorial Integrated Physicians, LLC 12,139 $171,013,621 $160,358,836 $6,703,734
NEQCA Accountable Care, Inc 35,261 $506,768,205 $489,561,739 $13,489,869

Twitter: @SusanJMorse
Email the writer: [email protected]



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