ACOs are groups of hospitals, physicians, and other healthcare providers who come together under a single ACO entity to provide care for their patients based on quality and cost-saving measures as opposed to a straight fee-for-service payment model. The goal of ACOs is to coordinate and improve the quality of care provided to patients while promoting cost-savings. ACOs can enter into agreements with both commercial and government payors. BMD has worked with clients to develop bother commercial and government ACOs.
BMD has developed commercial ACOs by bringing together primary care physicians and specialists in an ACO model and negotiating bundled payments with commercial payors. Clients for whom we have set up commercial ACOs have seen significant increases in reimbursement from payors. By employing an IPA model along with the ACO, our clients have also achieved significant cost-savings. Using this strategy, healthcare practices can receive increased bonus payments for meeting or exceeding established benchmarks and quality goals. Commercial payors may also be willing to infuse capital at the start of the programs to upgrade technology and allow for the employment of key staff such as patient to ensure the program’s success.
Under the government model, an ACO that has at least 5,000 Medicare beneficiaries may apply to participate in the Medicare Shared Savings Program (MSSP). The MSSP allows ACOs that successfully deliver high-quality care while reducing healthcare costs to share in the savings it achieves for the Medicare program. The ACO can also split its costs-savings with other providers that help it achieve its goals, which can be a useful tool in aligning practitioner incentives. Successful participants may also participate in the Advance Payment ACO Model Program, a supplementary incentive program for selected participants. Under this option, selected participants receive upfront and monthly payments, which they can use to make important investments in their care coordination infrastructure.