(Last Updated On: July 5, 2017)

At the end of 2016, CMS announced a new Advanced Alternative Payment Model (APM) for Track 1 participants and small providers, or even hospitals, who want to create an Accountable Care Organization. The ACO Track 1+ model is a hybrid of Track 1 and Track 3. While Track 1 is a one-sided risk model, Track 1+ incorporates the two-side risk model with the more popular elements of Track 1.(1) As with all existing ACO models, CareHarmony is a qualified third-party service provider that will help you meet ACO quality goals.

By combining different Track aspects, CMS minimized the risk for participants in Track 1+ through lower loss sharing rates and incorporating the flexibility of both Track 2 and Track 3. ACO Track 1+ is a great option for organizations that want to be part of an Advanced APM and receive the five percent incentive payment in 2019 for participation in 2017.(2) Participation will also give you the opportunity to avoid the penalties that non-MSSP participants will incur in 2019.

Increased Flexibility and Decreased Liability: How ACO Track 1+ is Different

Track 1+ is open to ACOs currently participating in Track 1 or new ACOs, but not Track 2 or 3 participants. By lowering the loss-sharing rate and providing more flexibility, CMS is hoping to attract physician-only groups and rural hospitals. The following is a list outlining details of the new program:

  • Loss sharing rate fixed at 30 percent
    • This percentage is based upon ACO composition
    • Physicians-only and rural hospitals may have lower levels of risk
  • Skilled nursing facility option
    • Option to request 3-Day Rule Waiver
  • Prospective beneficiary assignment
    • Allows ACO to know assigned populations in advance
  • Shared savings of up to 50 percent
  • Symmetrical thresholds that are available under Tracks 2 and 3(3)

ACO Track 1+: A Good Starter Program for Two-Sided Risk

Although a one-sided model is no longer available, the risk in ACO Track 1+ is much lower than other programs. CMS also added popular features of Tracks 2 and 3 to offset the costs. More importantly, switching to Track 1+ will not rebase the historical benchmark of Track 1 participants. This presents a good alternative to shifting to a stricter two-side risk model. By taking on the lower risk option now, ACOs can begin to prepare their organizations for higher risk programs they will join in the future.

Track 1+ is also attractive to groups or small providers looking to create a new ACO, since it is no longer possible to create a one-sided ACO. However, small providers and rural hospitals may not be able to afford the possible 10 to 15% loss rate that Tracks 2 and 3 could incur. The loss rate for ACO Track 1+ will range from four to eight percent, which is much more palatable for groups getting into a new program. Coupled with the possible shared savings and other benefits of this program, Track 1+ is a good entry plan for groups looking to create an ACO.

CareHarmony Can Help You Meet ACO Track 1+ Quality Measurements

Like all of Medicare’s Quality Payment Programs, CMS evaluates ACO Track 1+ on qualitative performance. CareHarmony provides services that meet all four quality-measure categories. The biggest component of CareHarmony’s service is care coordination. Implemented through the creation of Care Pathways by our skilled Care Coordinators, care coordination is an integral part of ACO quality measurements. Care Pathways are also integral to preventive health care and addressing at-risk populations. These categories are part of CMS’s metrics for determining the achievements of an ACO. In collaboration with CareHarmony, your ACO can also increase patient satisfaction. Your CMS surveys will reflect our excellent customer service. Contact us today, to see how we can help your organization can successfully adapt to the changing Medicare landscape.

Reference

  1. Centers for Medicare & Medicaid Services, “Fact Sheet,” New Accountable Care Organization Model Opportunity, 2017 May. [Online: June 27, 2017] https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/New-Accountable-Care-Organization-Model-Opportunity-Fact-Sheet.pdf
  2. Centers for Medicare & Medicaid Services, “APMs Overview,” Quality Payment Program, [Online: June 29, 2017] https://qpp.cms.gov/apms/overview
  3. Centers for Medicare & Medicaid Services, Medicare Accountable Care Organization Track 1+ Model, 2017, March 22. [Online: June 27, 2017] https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Medicare-Accountable-Care-Organization-ACO-Track-1+-Model-Webinar-slides.pdf