ACO updates likely to include equity factors

The Next Generation ACO model is set to expire at the end of the year.

If regulators decide to extend it, adding equity into the payment structure will likely be part of any update, said Emily Brower, senior vice president of clinical integration and physician services at Trinity Health. Its accountable care organization saved $85.6 million since the start of the model five years ago, Trinity said.

Ahead of the Centers for Medicare and Medicaid Services’ expected refresh of the Next Gen structure, the 91-hospital not-for-profit system is boosting its capability to collect patient race, ethnicity, income and other data by moving its disparate electronic health record systems to a single platform.

“It’s really a tremendous opportunity to understand the people we serve and do a better job caring for them,” Brower said.

Trinity Health ACO has also been asking for this data from its insurer partners, as well as working with CMS’ Health Care Payment Learning and Action Network organized to establish a common way to understand and collect the data.

The health system began participating in the Next Generation model in 2016, taking on high amounts of downside risk in exchange for bonuses based on improving health outcomes and lowering the costs for Medicare beneficiaries. It is one of 41 ACOs that currently participate in the model that saved Medicare more than $558 million in 2019, according to the most recent CMS data.

Next Gen’s overall impact on reducing spending while also improving quality has been questioned. Former CMS Administrator Seema Verma previously touted the model’s savings, but a subesquent CMS report contradicted her findings, noting that the model “did not lead to a statistically significant difference in spending over the first two performance years” compared with patients not enrolled in the program.

Under this payment model, Trinity Health ACO created networks among 15,000 providers who were then accountable for the clinical and financial outcomes of the patient population assigned to them. About half of the clinicians who participated in the Trinity ACO were independent providers not employed by the health system.

Although it is not uncommon for health systems to engage independent practices in their ACOs, Brower said Trinity’s approach helps smaller providers that may not have the resources to accept a large amount of downside risk necessary to participate in the model. This could help promote equity among the 770,000 patients who have access to this program—regardless of its future.

Physician participation in ACOs is lower in places with more vulnerable populations than in more affluent communities, which could exacerbate existing disparities in healthcare quality. Nearly 36% of primary-care providers working in ZIP codes with the lowest Black populations participate in an ACO, while 26% of clinicians working in ZIP codes with high proportions of Black populations were involved in one of these models, according to a 2016 Health Affairs report.

In October, CMS’ Innovation Center released the strategy refresh for all of its payment models, which included a strong commitment to addressing equity and understanding and closing health disparities.

“They’ve put a stake in the ground around that. It’s going to be the lens through which CMS launches any new model,” Brower said.