ACO updates likely to include equity factors

The next generation ACO model expires at the end of the year. If regulators decide to renew it, adding capital to the payments structure is likely to be part of any upgrade, according to Emily Brower, senior vice president of clinical integration and healthcare services at Trinity Health. Trinity said its accountable care organization has saved $ 85.6 million since launching the model five years ago.

Ahead of Medicare and Medicaid Services’s pending renewal of Next Gen, the 91-hospital nonprofit system is expanding its ability to collect data on race, ethnicity, income, and other patient data by moving disparate electronic health records. systems on a single platform.

“This is a truly amazing opportunity to understand the people we serve and take better care of them,” Brower said.

ACO Trinity Health also solicits this data from its insurer partners, and is also working with the CMS Healthcare Payment and Training Action Network to determine a common way of understanding and collecting the data.

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The healthcare system began participating in the Next Generation model in 2016, taking on the high risk of worsening the situation in exchange for bonuses based on improved health outcomes and lower costs for Medicare recipients. It is one of 41 ACOs currently participating in a model that, according to the latest data from CMS, saved Medicare over $ 558 million in 2019.

The overall impact of Next Gen in reducing costs while improving quality has been questioned. Former CMS administrator Sima Verma previously touted the model’s economy, but a subsequent CMS report contradicted her findings, noting that the model “did not result in a statistically significant difference in cost over the first two years of effectiveness” when compared to non-enrolled patients. …

Under this payment model, ACO Trinity Health created networks of 15,000 providers who were then responsible for the clinical and financial results of their assigned patients. About half of the doctors who participated in Trinity ACO were independent health care providers outside the health care system.

While health systems often use independent practices in their ACOs, Brower said Trinity’s approach helps smaller providers who may not have the resources to accept the large deterioration risk required to participate in the model. This could help to ensure equity among the 770,000 patients who have access to this program, regardless of its future.

Physician participation in environmental protection is lower in settings with more vulnerable populations than in wealthier communities, which may exacerbate existing disparities in the quality of health care. According to a 2016 Health Health study, about 36% of primary care providers working in zip codes with the lowest rate of blacks participate in the ACO, while 26% of doctors working in zip codes with high proportion of the black population have participated in one of these models. Case report.

In October, the CMS Innovation Center released an updated strategy for all of its payment models that includes a strong commitment to addressing equity, understanding and addressing health disparities.

“They staked around this. This will be the lens through which CMS launches any new model, ”Brower said.

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