The "Next Gen" ACO
Earlier this year, CMS announced the inaugural class of Next Generation ACO’s – the latest accountable care models - higher levels of financial risk and greater opportunity for reward than have been available within the Pioneer Model and Shared Savings Program. CMS’s goal is to test whether increased financial incentives, coupled with better patient engagement and care management, will improve health outcomes and lower costs for Medicare fee-for-service (FFS) beneficiaries.
One of the most exciting opportunities for these ACOs is the ability to leverage tele-health above and beyond what is currently permissible in fee-for-service Medicare.
Since section 1834(m) of the Social Security Act was codified well over a decade ago, tele-health has only been able to serve Medicare recipients after they’ve gotten in their cars and driven to a clinical site, in a rural area of the nation. Simply translated – no homes or cities count. With the lightning speed of tele-health advancement, this structure is archaic, limiting, and frankly at this point, senseless. Now, with this Next Gen designation, these “Next Gens” will be able to offer care through tele-health technologies regardless of the patient’s location.
So, why should each and every one of these ACOs in this premier class leverage tele-health as a part of their model? For them, the answer is engagement and revenue. For the rest of us – it’s proof. The more patients are engaged in their healthcare, the more successful an ACO will be. Telehealth offers the ability to offer on-demand availability, project care after hours, reduce travel time and expenses, and allows providers to quickly identify and address gaps in care. Combined with the high satisfaction rates tele-health has produced for its end users, Next Generation ACOs have before them a tool that will improve their ability to manage and empower their patients, and improve outcomes through greater touch points.
Then, of course, there’s the dollars. As ACOs make money by keeping the greatest number of patients healthy, tele-health is a key tool in driving revenue. The “anytime, anywhere” nature of tele-health allows ACOs to effectively compete with the rise of retail health clinics and increase covered lives by offering urgent care services 24/7. These technologies can also address increasingly overextended physician supply through load balancing and expand providers’ geographic reach.
The value of tele-health to the freshman class of Next Generation ACOs is undeniable, but these innovators have an ever greater role to play. They can lay the groundwork for the rest of the Medicare ecosystem. For years, tele-health advocates have been championing the cause of expanding tele-health reimbursement within fee-for-service Medicare. And for as many years, the pushback from decision makers has been the unfounded belief that increasing access to tele-health will result in increased costs. Despite concrete proof in the commercial environment that each tele-health encounter saves money, the lack of data from within the Medicare population has resulted in an impasse. These Next Gens have the ability to create the very proof tele-health champions have been waiting for – concrete evidence of the value of tele-health for Medicare enrollees, regardless of who or where they are. #weshouldtalk