Among many other things, the Affordable Care Act spawned Medicare Accountable Care Organizations (ACO). The ACO provision has enticed over 250 provider organizations to enter into gain and risk sharing arrangements with Medicare. Unfortunately, the more successful a Medicare ACO is at managing the costs of care, the lower its benchmark will be in subsequent three-year contract periods. This virtually guarantees that a Medicare ACO will lose money over the long term. Medicare ACOs need an exit strategy that allows them to continue to generate returns from their care management programs, after their ACO margins evaporate.
We see two good options for Medicare ACOs contemplating their next step. Developing a risk contract partnership with a Medicare Advantage plan enables the ACO to accept execution risk (how efficiently it provides care) while the MA plan retains insurance risk (the incidence of disease). Or, by developing their own insurance capabilities, ACOs can realign themselves as MA plans. Either option offers the potential for better long-term profitability for Medicare ACOs that have developed successful care management programs.
We understand Medicare ACOs: We have helped launch seven or eight over the past two years. But we also understand that this is just a first step toward taking greater control over the Medicare revenue stream by “moving up the food chain.” Our team of veteran executives can help your ACO evaluate the options, manage the workflow to achieve either a Medicare Advantage contract with CMS or a risk contract with an existing MA plan, and continue to achieve improved outcomes. Our comprehensive management solutions provide ACOs in transition with the tools, processes, and expert guidance to drive overall performance through new models of finance, leadership, and clinical value.
• Care Management
• Provider Network Engagement
• Patient Engagement
• Ongoing Data Analytics, Reporting, and Monitoring
We’re standing by to help you make sense of the regulatory landscape and chart a sustainable course for success in your Medicare business.