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Telemedicine a Key Component of Next-Generation ACOs

The new model, unveiled this week, lifts restrictions on telemedicine use and enables the 21 participating ACOs to create a better network of care for patients.

By Eric Wicklund

- A new Accountable Care Organization model that stresses telehealth is getting high marks from the American Telemedicine Association.

The Next Generation ACO Model, unveiled on January 11 by the Centers for Medicare & Medicaid Services, targets ACOs that have seen success in population health initiatives – including working with Medicare Shared Savings or Pioneer ACO models - and are ready to assume more risk and reward. The model also gives them more freedom to use telemedicine platforms to connect with patients outside the traditional healthcare setting.

In unveiling the NGACO, which had been on the drawing board for more than a year, CMS announced that 21 ACOs across the country will adopt the model. It and other ACO models are designed to meet the Administration’s goal of tying 30 percent of traditional Medicare payments to alternative payment models by the end of 2016 and boosting that percentage to 50 percent by the end of 2018.

"Today is an important day for Medicare beneficiaries getting access to value-based telehealth care," Gary Capistrant, Chief Policy Officer of the ATA, said in a press release. "We think all Medicare ACOs should be able to use telehealth to provide the Medicare range of coverage, and we hope that Congress and CMS will explore allowing more use of innovation to serve better Medicare beneficiaries."

“Americans will get better care and we will spend our healthcare dollars more wisely because these hospitals and providers have made a commitment to change how they do business and work with patients,” HHS Secretary Sylvia M. Burwell said in announcing the NGACO and two other ACO initiatives. “We are moving Medicare and the entire health care system toward paying providers based on the quality, rather than the quantity of care they give patients. The three new ACO initiatives being launched today mark an important step forward in this effort.”

“Unlike other models, this model includes a prospectively (rather than retrospectively) set benchmark, allows beneficiaries to choose to be aligned to the ACO, and tests beneficiary incentives for seeking care at Next Generation providers, including increased availability of telehealth and care coordination services,” CMS officials said in a separate press release.

“The Next Generation Model participants will have the opportunity to take on higher levels of financial risk – up to 100 percent risk – than ACOs in current initiatives,” CMS added. “While they are at greater financial risk they also have a greater opportunity to share in more of the model’s savings through better care coordination and care management. In addition, the ACOs will receive their budgets prospectively, in advance of the performance year, to plan and manage care around these financial targets from the outset. The ACOs will also be able to select from flexible payment options, such as infrastructure payments that support ACO investments in care.”

When plans for the NGACO were aired in early 2015, critics questioned whether participating health systems would be able to keep their patients from using services outside the ACO, which would negatively affect quality and cost measurements. Supporters, meanwhile, said the NGACO’s ability to use telemedicine platforms would expand the network and better meet patient needs.

"This policy is a critical step forward in expanding the use of telehealth services in Medicare, which will allow for greater care coordination and improved quality of care," Joe Peterson, MD, chairman of the Alliance for Connected Care, said in a March 2015 press release. "It represents a major victory for patients and the broader telehealth community, which has been gathering evidence of telehealth's benefits for decades."


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