Prevalence of risk-bearing ACOs increasing under Medicare programs, Avalere says

More Medicare ACOs are taking on upside and downside risk under CMS' Medicare Shared Savings Program and Next Generation ACO Model, according to innovation company Avalere.

The two-sided risk allows participants to receive bonuses if a certain outcome is met or face penalties if costs are higher than a specific benchmark.

Under the Medicare Access and CHIP Reauthorization Act, APMs that require providers to bear more than nominal risk will qualify as "advanced." CMS' advanced APMs include three types of ACOs — the Medicare Shared Savings Program, the Next Generation ACO Model and the Comprehensive End-Stage Renal Disease Care Model — as well as the Comprehensive Primary Care Plus Model. Clinicians participating in advanced APMs can earn a lump sum bonus of up to 5 percent on Medicare payments.

Among the 525 ACOs participating in the MSSP and Next Generation ACO Model payment initiatives, 87 are participating in the two-sided risk arrangements, up from the 49 ACOs that participated in the two-sided arrangement in 2016, according to Avalere.

"As existing models are refined, new models are released and programs such as the Quality Payment Program [under which clinicians in APMs receive the lump sum bonus of up to 5 percent] are implemented, the number of risk-bearing Medicare ACOs will continue to grow," according to Avalere.

Specifically, Avalere said CMS predicts between 125,000 and 250,000 of eligible clinicians, or up to 25 percent in the QPP, will be part of an advanced APM in 2018.  

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