CMS: Accountable Care Organization Branch Out to Medicaid with Latest Dual Eligible Model

A latest type of accountable care organization (ACO) is in the works for beneficiaries who account for a disproportionate share of home health spending, the Centers for Medicare & Medicaid Services (CMS) declared. The dual eligible model might assist to pay for some of the sickest—and most expensive—sufferers in coordinated care models.

Dual eligible model beneficiaries qualify for both Medicare and Medicaid. In home health, they cost almost twice as much as non-dual-eligible beneficiaries in the year of 2012, in accordance to the Medicare Payment Advisory Commission (MedPAC), a commission that advises Congress on payments to health plans and providers in Medicare.

Aiming to make better the quality of care and decrease charges for this group of enrollees, the latest Medicare-Medicaid ACO builds on the current Medicare Shared Savings Program.

The ACO concept is a group of several health care providers that work together to coordinate care to make better the quality of care and lower charges. One aim is incentivizing hospitals, physicians, and post-acute providers—involving home health—to work together more closely.

Health care providers that meet cost thresholds can share in savings, while those that do not meet thresholds confront financial fines or penalties. But up until now those rewards and penalties just have engaged Medicare payments, meaning ACOs don’t have financial accountability for Medicaid expenditures for dual eligible model sufferers, in accordance to CMS.

Under the latest ACO model, Medicaid payments also now will be involved.

“On the surface, a Medicare-Medicaid ACO could prove to be helpful for home- and community-based care because it would permit for consideration of combining Medicare and Medicaid home care benefits to briefly handle a sufferer in his/her own home, instead of working only within a more restricted Medicare home health benefit,” William Dombi, vice president for law at the National Association for Home Care & Hospice (NAHC), told HHCN on the agency’s preliminary assessment.

The new model comes as care coordination has become a top key priority across the health care system, and particularly home health care providers.

“This model targets to give better care coordination for those enrolled in both Medicare and Medicaid, permitting providers to focus more on providing care for their sufferers instead of administrative work,” Dr. Patrick Conway, CMS acting principal deputy administrator, claimed in a statement.

The latest model further pushes CMS’ attempts to shift away from fee-for-service and toward value-based care. Moreover, there has been a latest push to align Medicare and Medicaid programs for dual-eligible model beneficiaries by the Bipartisan Policy Center (BPC), a nonprofit think tank based in Washington D.C.

Home health care providers have increasingly become partners in care coordination programs, involving ACOs.

As payments sustain to shift toward value instead of volume, home health care providers can position themselves to be care coordination partners, where they might also be capable to share in any savings.

CMS is accepting letters of intent from states to work with CMS on the model for certain state-particular elements. The agency will step into participation agreements with up to 6 states. Once a state is passed, an appeal for application will be issued to ACOs and health care providers in that state.