AMERICA’S ACO INFORMATION FOR PROVIDERS
America’s ACO was initiated on January 1, 2020 as an MSSP ACO to proactively respond to federal initiatives by CMS aimed at coordinating patient care to reduce system waste and
achieve better patient outcomes. The formation of America’s ACO allows participating providers to embrace innovative CMS payment models that reward efficient quality care, and
in efforts to preserve financial solvency and independence in the midst of paradigmatic change and reform in the current value-based healthcare environment.
As a healthcare provider, must I participate in a Medicare Shared Savings Program ACO?
Participating in an ACO is purely voluntary for providers.
What type of Medicare Shared Saving Program ACO is AMERICA’S ACO?
America’s ACO is a level E two-sided risk Medicare Shared Savings Program ACO under the new “Pathways to Success” Program. The level E ACO status qualifies for participation in an advanced alternative payment model under the Quality Payment Program. Providers participating in an advanced alternative payment model are eligible to receive additional incentive payments from CMS and are exempt from participation in merit-based incentive payment system, or MIPS, reporting requirements and potential downward payment adjustments.
Why should I consider participating with America’s ACO)?
2. Full access to the robust state-of-the art Guardian Health Information Exchange (HIE) platform. The Guardian HIE architecture provides the capability for a) electronically moving clinical information among and between disparate providers and information systems, while maintaining the meaning of the information being exchanged, b) building a complete and fluid real-time view of a patient (Patient Master Chart), through longitudinal integration of patient health data/information at points of care, c) accessing the right information at the right time for clinical decision-making, and avoiding duplication of services and reducing medication and medical errors, d) optimizing compliant and audit-proof medical risk adjustment, e) monitoring and comparing performance relative to outcome parameters across the network, and f) engaging the patient through portal access to their own personal medical data, and g) fully satisfying the technology requirements of MIPS and APMs.
transitions of care, b) analytic modeling and stratification of high risk patients with corresponding opportunities for engagement with formal complex care management
services, c) on-going identification and closure of quality performance measure gaps, d) effective referral management to ensure timely and cost-efficient coordination of care, e)
systematic monitoring of medical risk adjustment and HCC coding and documentation, f) diversion of patients from inappropriate use of ERs, and g) a comprehensive telemedicine
program, and h) systematic monitoring patient experiences and satisfaction with care on the practice/provider level.
Can I participate in multiple Medicare Shared Saving Program ACOs?
Each taxpayer identification number or CMS Certification Number (CCN) billing Medicare for primary care services (as defined in the MSSP regulations at §425.20) must be exclusive to one MSSP ACO’s certified list of ACO participants. Exclusivity in America’s ACO only applies to Medicare FFS and does not preclude you or your practice from participating in other IPA or payer network arrangements.
According to CMS, the following provider types must be exclusive to a single ACO:
- Addiction medicine
- Geriatric psychiatry
- Medical oncology
- Multispecialty clinic or group practice
- Osteopathic manipulative medicine
- Physical medicine and rehabilitation
- Preventive medicine
- Primary care (e.g., internal medicine, general practice, family practice, geriatric medicine, or pediatric medicine)
- Pulmonary disease
- Sports medicine