Benefits of Participating

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The Value of Joining ACN for a Primary Care Provider

ACN provides a broad range of clinical and care coordination services for nearly 250,000 adult and pediatric patients in greater Phoenix via the coordinated efforts of over 4,000 physicians. ACN's mix of value-based agreements and products with various health plans, governmental payors and self-funded employers offer PCPs quality incentives and gain sharing opportunities tied to reductions in overall health care utilization for covered populations.

Participation in these value-based contracts and health plan products offered by ACN provide PCPs with:

  • Access to new patients via inclusion on various commercial, Medicare and direct-to-employer agreements
  • Retention of existing patients who may be otherwise required to change providers to remain in-network under their existing plan
  • Incentives and gain sharing opportunities, otherwise not available to primary care providers, for meeting certain quality, physician loyalty, patient satisfaction and resource utilization criteria for covered patients. ACN will share nearly $2.5 million in incentive and shared savings distributions with providers for their efforts in population health management, quality improvement and reductions in the cost/utilization of health care services for patients the network cared for under its various value-based agreements in 2015
  • Platform to associate professionally with a large physician network that strives for excellence in access to care, quality and patient experience in an effort to strengthen the reputation of each ACN provider
  • Opportunity to participate in the governance of the organization as a voting member (stipend provided) on one of 5 physician committees, and ultimately the Board of Managers
  • Access to population health management tools, data and care coordination personnel employed by ACN to assist providers in ensuring their patients improve and maintain optimal health. ACN’s centralized and embedded care coordination team assists providers in performing various population health activities to ensure patients have timely visits with their primary care provider and receive care from in-network providers, which helps prevent unnecessary utilization of costly emergency department and hospital services
  • Improved potential for qualifying for reimbursement increases from CMS beginning in 2019 under the Merit-based Incentive Payment System (MIPS).* Smaller practices are projected to do poorly under MIPS; 60% or more of practices under 25 providers are projected to be penalized under MIP
  • Opportunity to earn participation status in ACN’s Next Generation ACO, which will help providers qualify for participation in an Advanced Alternative Payment Model (APM). Participation in an APM exempts providers from MIPS and ensures an additional 5% bonus in reimbursement for Part B services between 2019-2024*

* Source(s): CMS, “Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models,” May 9, 2016, available at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-10032.pdf

 

Mechanics of the Medicare Shared Savings Program (MSSP)

Applying Total Cost Accountability to Fee-for-Service Payments

MSSP in brief:

  • Program began January 1, 2013; contracts to last a minimum of three years
  • Physician groups and hospitals eligible to participate, but primary care physicians must be included in any ACO group
  • Participating ACOs must serve at least 5,000 Medicare Fee-for-Service beneficiaries
  • Shared savings distribution potential depends on Medicare cost savings, quality metrics
  • Two payment models available: one with no downside risk, the second with downside risk in all three years

A Physician and Health System Collaboration