Nation-Leading Partnership Paves Way for CMS Next Generation ACO
ThedaCare ACO, a collaboration between ThedaCare and a number of independent physician partners, is announcing its participation in the Next Generation ACO Model, the Centers for Medicare & Medicaid Services’ (CMS) newest Accountable Care Organization (ACO) model. For the last three years, ThedaCare has participated in CMS’s Pioneer ACO Model through collaboration with Bellin Health under Bellin-ThedaCare Healthcare Partners. The partnership received national recognition for generating nearly $14 million in savings and achieving the highest quality scores; it has been the highest quality, lowest cost ACO for Medicare in the country.
CMS describes the Next Generation ACO Model as an initiative for ACOs experienced in coordinating care for populations of patients. The model will allow organizations like ThedaCare to assume higher levels of financial risk and reward than are available under the Pioneer ACO Model and CMS’ other ACO programs and initiatives. Since passage of the Affordable Care Act, 477 Medicare ACOs have been established in 49 states and the District of Columbia, serving nearly 8.9 million Americans with Medicare.
Twenty-one ACOs from across the nation will participate in the Next Generation ACO Model. The initial commitment is three years, with two optional one-year extensions allowed. ThedaCare is included in the first group of participating organizations beginning January 1, 2016.
ThedaCare has moved beyond the Pioneer, said Dean Gruner, MD, president and CEO of ThedaCare. “Our participation in these models benefits all of our patients because we take what we learn and spread it throughout ThedaCare. We are redefining better,” Dr. Gruner said Next Generation offers greater opportunities for patient engagement, including increased care coordination, home visits, and using video conferencing to connect patients with specialists.
Bellin-ThedaCare Healthcare Partners has experienced great success since being selected in 2011 as one of the 32 organizations to join the Pioneer ACO Model, which began the following year. In its three years of participation, the partnership generated $7.6 million, $3.2 million, and $3.1 million in savings for Medicare, respectively.
At the same time, Bellin-ThedaCare Healthcare Partners was the indisputable leader in cost and quality while caring for the 20,000 Medicare beneficiaries in Northeast Wisconsin aligned through the Pioneer ACO Model. Among the participants, Bellin-ThedaCare Healthcare Partners had the highest quality score for the 33 metrics measured by CMS in the past two years. Within that same time frame, the ACO partnership held the per-beneficiary costs for delivering care lower than any other participant in the national model.
“Our goal is to deliver the highest quality health care, improved patient experience, and do so at the lowest cost,” said David Krueger, MD, Executive Director of ThedaCare ACO. “Our patients and communities are counting on us to reach these goals and we are looking for every opportunity to succeed in this endeavor.”
Accountable Care Organizations are comprised of groups of doctors, hospitals, and other healthcare providers and suppliers who come together to provide coordinated, high-quality care at lower costs for patients. In shared savings models, targets are set for healthcare costs and quality for a defined population of patients, with an incentive for ACOs to receive a portion of savings if the amount spent is lower than the projected amount and quality benchmarks are achieved. Risk is also assumed with participation in shared savings models, with the potential to receive lesser reimbursement if costs are higher than projected or quality measures are not met.
For more than 100 years, ThedaCare™ has been committed to finding a better way to deliver serious and complex healthcare to patients throughout Northeast Wisconsin. The organization serves more than 200,000 patients annually and employs more than 6,800 healthcare professionals throughout the region. ThedaCare has seven hospitals located in Appleton, Neenah, Berlin, Waupaca, Shawano, New London, and Wild Rose and 35 clinics in 14 counties. ThedaCare is the first in Wisconsin to be a Mayo Clinic Care Network Member, giving our specialists the ability to consult with Mayo Clinic experts on a patient’s care. ThedaCare is a non-profit healthcare organization with a level II trauma center, comprehensive cancer treatment, stroke, and cardiac programs, and a foundation dedicated to community service. Construction of ThedaCare Regional Cancer Center in Appleton is underway. For more information, visit www.thedacare.org or follow ThedaCare on Facebook and Twitter.