MemorialCare Regional ACO chosen for CMS initiative to build on success of ACOs

Next Generation” ACO model sets stronger measures and more opportunities for care

MemorialCare Regional ACO has been selected to participate in the Centers for Medicare & Medicare Services (CMS) new accountable care organization (ACO) model called the Next Generation ACO Model (NGACO Model), advancing the Administration’s health care system goals and building on experience from the Pioneer ACO Model and the Medicare Shared Savings Program. Through this new model, CMS will partner with MemorialCare Regional ACO and other ACOs experienced in coordinating care for populations of patients and whose provider groups are ready to assume higher levels of financial risk and reward. This is in accordance with the Department of Health and Human Services’ goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to alternative payment models, such as ACOs, by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.

“We are exceptionally pleased to have been chosen to participate in the NGACO Model because of our significant experience in providing high quality, coordinated care,” said Mark Schafer, M.D., CEO of MemorialCare Regional ACO. “We are excited to partner with CMS in the Next Generation ACO Model, one of many innovative payment and care delivery models created under the Affordable Care Act, and feel this is an important step towards advancing models of care that reward value over volume in care delivery.”

Since Medicare Shared Savings Program and Pioneer ACOs began in 2012, and now, the Next Generation ACOs – Medicare ACOs have grown to 477 nationwide, serving nearly 8.9 million beneficiaries. The results from the past 5 years have demonstrated that as ACOs gain more experience in these programs, their performance improves in providing better quality of care for beneficiaries, while producing savings.

The 21 ACOs participating in the NGACO Model in 2016 have significant experience coordinating care for populations of patients through initiatives, including, but not limited to, the Medicare Shared Savings Program and the Pioneer ACO Model. The NGACO Model organizations represent a variety of provider organizations and geographic regions, and were selected by fulfilling specific eligibility criteria outlined in the Request for Applications found at the Next Generation ACO Model web page. These organizations were selected through an open and competitive process from a large applicant pool that included many qualified organizations.

“We look forward to working with our newly selected Next Generation ACO model participants to move our health care system toward one that delivers better care, smarter spending, and healthier people,” said Patrick Conway, M.D., Deputy Administrator and Chief Medical Officer for CMS. “This ACO model responds to stakeholder requests for the next stage of the ACO model that enables greater engagement of beneficiaries, a more predictable, prospective financial model, and the flexibility to utilize additional tools to coordinate care for beneficiaries.”

The MemorialCare Regional ACO is jointly operated and governed by agreement with participating physician groups, individual physicians, and subsidiaries of Memorial Health Services (“MHS”)/MemorialCare Health System, a nationally recognized not-for-profit integrated delivery system which operates six not-for-profit hospitals, physician offices, ambulatory diagnostic and surgical centers, rehab services, mental health services, urgent care centers and a home health agency. The MemorialCare Regional ACO is a wholly owned subsidiary of the MemorialCare Medical Foundation (the “Medical Foundation”), a California not-for-profit public benefit corporation which is a wholly owned subsidiary of MHS. The Medical Foundation has managed physician groups in the counties of Los Angeles and Orange in Southern California for over 30 years, working closely with primary and specialty care physicians to provide outstanding service, high quality and efficient medical care in outcomes-based reimbursement models.

For more information about the MemorialCare Regional ACO, please visit our MemorialCare Regional ACO web page.

The Next Generation ACO Model is part of the Department’s efforts to create opportunities for providers to enter into alternative payment models and meet the Secretary’s goals announced on January 26, 2015 to move an increasing percentage of Medicare payments into models that pay providers based on the quality rather than the quantity of care they provide patients.