A quick guide to CMS ACO payment models

A variety of Accountable Care Organization (ACO) models have been established by The Centers for Medicare & Medicaid Services (CMS) and by commercial payers. In all types of CMS ACO and commercial ACO models, whether it’s a CMS ACO or commercial ACO, providers are eligible for bonuses based on savings and outcomes.

Most visible and often discussed, are the several different ACO models offered by CMS, including:

• Medicare Shared Savings Program. The Medicare Shared Savings Program (MSSP) encourages coordination among providers to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs. Eligible providers, hospitals and suppliers may participate.
• Advance Payment ACO Model. The Advance Payment ACO Model is designed for physician-based and rural providers who have come together voluntarily to deliver well-coordinated, high-quality care to the Medicare patients they serve. Through the Advance Payment ACO Model, selected caregivers receive upfront and monthly payments, which they can use to invest in their care coordination infrastructure.
• Pioneer ACO Model. The Pioneer ACO Model is designed for health care organizations and providers already experienced in coordinating care for patients across care settings. It enables these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Services Program.

The program is designed to work in coordination with private payers by aligning provider incentives. This is intended to improve quality and health outcomes for patients across the ACO, and achieve cost savings for Medicare, employers and patients.