Learning Hub

July 05, 2018

How Might the White House’s Proposed Changes on ACOs Impact You?

The White House recently hinted at potential changes coming to rules that would impact Accountable Care Organizations (ACOs). Discussed in Modern Healthcare, these changes are in response to Accountable Care Organizations failing to meet MSSP requirements, as proposed in the Affordable Care Act.

Joseph Grogan, the White House’s Office of Management and Budget’s associate director of health programs, discussed at The National ACO, Bundled Payment and MACRA Summit why regulations were needed amongst the current rules and model for Medicare Shared Savings Programs ACOs. The main issue is that ACOs under MSSP are not saving Medicare enough money. In 2010, the Congressional Budget Office estimated that the Medicare Shared Savings Programs ACOs would save $4.9 billion through 2019. Grogan discussed at the Summit that these models actually cost the agency $384 million between 2013 and 2016. The Office of Management and Budget suggested on their website that policy changes were coming by posting a proposed rule that would work to transition ACOs to lower risk contracts.

Though Grogan did not speak specifically about the rule while attending the Summit, clinicians working with ACOs believe the rule will decrease the allowed amount of time ACOs can stay in the Medicare Shared Savings Program. Under the Affordable Care Act, ACOs had the option to stay in an upside-risk contract, known as Track 1, for up to six years. This new rule, which was submitted by the HHS on May 1st, will shorten that time period to 3 years or 1 year, as they then transition into a downside-risk contract. Currently, 82% of the 561 Medicare ACO’s are in Track 1; therefore, this rule change will impact a large majority of Medicare ACOs. The rule is up for review by the OMB until August 1st. This rule change could require ACOs to be evaluated, maybe sooner than expected, to ensure that as an organization they are passing money saving goals, as well as handling the transition to a downside risk contract.

 Boncura has successfully helped ACOs with taking on additional downside risk. We help organizations measure care quality and manage and report on patient data. If your ACO needs assistance with case management and utilization management, Boncura can help. With an experienced team and modern software, we can ensure that your reporting efforts and data management are accurate and will assist your organization in taking on downside risk. If you’re struggling with the transition to taking on downside risk, we can help. Contact us to learn more.

About Boncura Health Solutions
Since 2011, Boncura Health Solutions has remained a dynamic organization aimed at improving patient outcomes, efficiently managing at-risk populations to reduce unnecessary healthcare costs, delivering services in a cost-effective manner, and providing unique and convenient ways for patients, providers, and clients to access key support services. Founded by physicians, Boncura’s expertise allows hospitals and health systems, independent physician groups, and accountable care organizations to provide value-based care through efficient and intelligent administrative and clinical services. Today, Boncura serves more than 7,000 physician providers and partners, managing upwards of 450,000 lives, and processing more than eight million claims annually.