As Accountable Care Organizations (ACOs) continue to evolve, the Centers for Medicare & Medicaid Services (CMS) continue to encourage physicians to assume financial risk for the patients attributed to their ACO. In fact, the most recent changes by CMS incentivize physician ACOs to assume greater upside risk by minimizing downside risk.
These models are based on comparing the actual cost of care for a defined population of Medicare fee-for-service beneficiaries with the anticipated cost for delivering care to that same population. If the actual costs are less than the anticipated costs, then the ACO – and its physician members – share in the savings.
Those ACOs with well-conceived and well-deployed care management programs can often achieve significant savings and earn handsome bonuses. From robust preventive care, to post-discharge follow up, to ensuring medication adherence, successful ACOs produce better health outcomes, prevent hospitalizations, and reduce overall healthcare spending.
For these forward-looking ACOs, the more patients attributed to their organizations, the greater the opportunity to demonstrate savings. Likewise, for the physicians who comprise these ACOs, patient attribution can mean significantly greater income.
Voluntary Alignment Trumps Claims Data
Historically, a Medicare fee-for-service beneficiary who elects to participate in an ACO would be aligned with the doctor who provided the most care to that patient over the previous twelve months. Therefore, if a patient’s Medicare claim data shows his or her cardiologist as the doctor who delivered the most care, then the cardiologist would be considered the patient’s “primary physician.”
Now, with voluntary alignment, patients can identify their primary physician on their own, independent of claims data. This ensures patients’ primary care doctors – those who likely have the most thorough and holistic understanding of the patient’s health – serve as the “captain” of patient’s care team.
How Does A Patient Align With A PCP?
This concept of voluntary alignment makes good sense for patients as well as their physicians. However, as is the case with many Medicare-related enterprises, bureaucracy can make processes challenging. Voluntary alignment is no exception to the rule.
For this reason, at Genuine Health ACO, we’ve created a program specifically focused on voluntary alignment. We do the heavy lifting so our physicians and their office staff don’t have to. As a result, physicians who participate in Genuine Health ACO often benefit from a 20% to 30% increase in Medicare fee-for-service patients attributed to their care.
That can mean tens of thousands of dollars in incremental revenue – not only from shared savings, but also from performance bonuses that Genuine Health ACO pays to its participating physicians when they meet certain criteria. In addition, our participating physicians earn higher reimbursement for their patients attributed to our ACO.
ACOs and value-based care offer a win-win for Medicare fee-for-service beneficiaries and their primary care providers. However, it’s vital these patients are attributed to the correct doctor. And Genuine Health's Miami Accountable Care Organization has created a voluntary alignment program to make certain our participating physicians get the credit and the income for every patient possible.
Learn more how Genuine Health's Miami ACO can help streamline the voluntary alignment process for your practice by contacting Gamil Kharfan, Chief Growth Officer for Genuine Health, at (786) 878-5500, or firstname.lastname@example.org.