There are 41 accountable care organizations in the CMS' Next Generation ACO Model for 2019, which represents a substantial decline from 2018 when 51 organizations were in the model.
Data updated on CMS' site this week shows that 12 ACOs that participated in 2018 have either left or were booted from the program for the 2019 performance year. The latest exodus of participants comes after the model lost seven ACOs in March 2018, bringing the total number of participants in 2018 down from an initial 58 to 51.
The drops in participation are in stark contrast from the upward trend the program experienced from 2017 to 2018. In 2017, there were 44 ACOs in the model and 14 joined for the 2018 performance year. The model was launched by the CMS' Center for Medicare and Medicaid Innovation in 2016 and will end in 2020.
But the participant drop doesn't necessarily mean the ACOs have abandoned their efforts to move to risk-based payment models, experts say. Instead, many likely left the program to join the Medicare Shared Savings Program (MSSP) in July.
"The majority of ACOs ending participation in the Next Generation ACO Model appear to want to continue in the Medicare Shared Savings Program," said Clif Gaus, CEO of the National Association of ACOs, in statement. "Their transition shouldn't be viewed as a negative reflection of the ACO model. In fact, some of these ACOs generated substantial savings for the Medicare program as Next Gen ACOs."
Changes made to the MSSP program this year offer similar benefits under the Next Generation ACO Model, particularly the enhanced track, said John Feore, associate principal at consultancy Avalere Health.
Both the enhanced track and Next Generation ACOs are on the hook for 15% in potential losses. And ACOs in the enhanced track of MSSP can get higher savings than Next Gen ACOs, likely adding to the appeal.
Additionally, MSSP now offers similar waivers as the Next Generation model. ACOs in downside risk agreements within the program are eligible to apply for the SNF 3-day rule and telehealth services.
"They (the CMS) have adopted a lot of the things in Next Gen," Feore said.
The CMS also waved off the decline in enrollment in a statement to Modern Healthcare.
A CMS spokesman said the agency "expected some organizations to move out of the model over time as they make strategic plans, assess long-term goals and participate in other CMS Alternative Payment Models (APMs) including the Medicare Shared Savings Program."
Some ACOs also might have left or were kicked out of the program for poor performance in 2018. The CMS has not yet released 2018 performance metrics.
ACOs no longer in the Next Generation ACO model in 2019
- Bronx Accountable Healthcare Network
- D-HH Accountable Care
- Hill Physicians Medical Group
- Integra Community Care Network
- Michigan Pioneer ACO
- Mission Health Coordinated Care
- National ACO
- One Care VT
- Partners Community Physicians Organization
- Physician Partners
- Regal Medical Group
- UniPhy ACO
Note: Some of these ACOs may have been acquired or merged with another ACO.