Advance Payment ACO Model

The Advance Payment Model is designed for physician-based and rural providers who have come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Through the Advance Payment ACO Model, selected participants will receive upfront and monthly payments, which they can use to make important investments in their care coordination infrastructure. 

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There are 35 ACOs participating in the Advance Payment ACO Model. (List)
To view an interactive map of this Model, visit the Where Innovation is Happening page.

 

The following Advance Payment ACOs were announced for the performance period that began on April 1, 2012:

Coastal Carolina Quality Care, Inc (New Bern, NC)

Coastal Carolina Quality Care is an ACO created to serve Medicare fee-for-service beneficiaries in North Carolina. Coastal Carolina Health Care, the ACO’s sole participant, is a physician-owned and operated medical practice with over 50 providers. The majority of these providers are Family Practice and Internal Medicine. In addition, the medical practice offers subspecialty care which includes Cardiology, Critical Care, Gastroenterology, Hematology, Oncology, Neurology, and Pulmonology. The medical group cares for more than 11,000 Medicare fee-for-service beneficiaries which accounts for more than half of its care delivered. The medical group works closely with the area’s hospitals, nursing homes, home health and hospice providers, free clinics, and other community providers and plans to take steps to strengthen these relationships through this program.

 


Jackson Purchase Medical Associates, PSC (Paducah, KY)

The Jackson Purchase Medical Associates consists of six medical groups, all sharing the same mission and desire to provide high quality medical care to its community. The facilities offer full service on site laboratory and diagnostics. The six medical groups are: Ballard County Medical Clinic - a walk in clinic that was developed as a cooperative effort between Ballard County and the City of Barlow and Jackson Purchase Medical Associates and is located in Barlow, KY; Internal Medicine Group - an 8 physician practice; Paducah Endocrinology - a single physician practice dedicated to the treatment of diabetes and metabolic disorders; Paducah Family Medicine - a 3 physician family practice; Paducah Rheumatology - a single physician practice dedicated to the treatment of arthritis and connective tissue diseases, including rheumatoid arthritis, osteoarthritis, lupus, scleroderma, gout, vasculitis, and other inflammatory disorders; RediCare - a physician led walk in center; and Western Kentucky Kidney Specialists - a 2 physician practice dedicated to treating diseases of the kidney. The Jackson Purchase Medical Associates, PSC serves Medicare beneficiaries in the Jackson Purchase area of Western Kentucky centered in Paducah. The ACO is expected to serve nearly 6,000 beneficiaries.

 


North Country ACO (Littleton, NH)

North Country Accountable Care Organization (North Country ACO), located in Littleton New Hampshire, is dedicated to promoting better care coordination, improving patient outcomes and creating a collaborative environment across healthcare systems in rural northern New Hampshire and Vermont. Participants of the North Country ACO include Ammonoosuc Community Health Services, Coos County Family Health Services, Indian Stream Health Center and Mid-State Health Center. All of the North Country ACO participants are members of North Country Health Consortium (NCHC). The community health centers have relationships with each other, as well as strong associations with their community partners, including community hospitals, home health agencies, community mental health centers, and emergency medical services. Collaboration through this long-standing, unique rural network provides critical opportunities for coordination which result in reduced hospital re-admissions and emergency department use, and improved health outcomes. The ACO is expected to serve nearly 6,000 beneficiaries.

 


Primary Partners, LLC (Clermont, FL)

Primary Partners mission is to provide quality, clinically integrated patient-centered care while allowing primary care physicians to continue operating independent practices. Its participating primary care physicians are located in Lake, Orange, Osceola and Polk Counties. It is expected to serve about 7,500 beneficiaries.

 


RGV ACO Health Providers, LLC (Donna, TX)

RGV ACO Health Providers, LLC (ACO) is a comprehensive, patient-centered ACO composed of six primary care group practices with ten clinic locations collaborating to coordinate the provision of quality medical care through its provider participants. Located in Hidalgo County, Texas, the ACO serves the South Texas populations of Weslaco, Mercedes, Elsa, Donna, Mission and surrounding communities. The ACO participant providers will be able to offer their patients assigned care coordinators, a nutritionist and extended hours of operation to improve the access and the quality of care of the population served by the ACO and its participating providers. With the implementation of “medical homes”, this particular ACO is designed to increase patient access to providers 24 hours-a-day. The ACO is expected to serve over 6,000 beneficiaries.

 

The following Advance Payment ACOs were announced for the performance period that began on July 1, 2012:

Accountable Care Partners ACO, LLC (Jacksonville, FL)

Accountable Care Partners, LLC, located in Jacksonville, Florida, is comprised of ACO group practices and networks of individual ACO practices, with 65 physicians. It will serve Medicare beneficiaries in Florida and Georgia.

 


Coastal Medical, Inc. (Providence, RI)

Coastal Medical, Inc., located in Providence, Rhode Island, is comprised of ACO group practices, with 100 physicians. It will serve Medicare beneficiaries in Massachusetts and Rhode Island.

 


Cumberland Center for Healthcare Innovation, LLC (Nashville, TN)

Cumberland Center for Healthcare Innovation, LLC, located in Nashville, Tennessee, is comprised of networks of individual ACO practices, with 33 physicians. It will serve Medicare beneficiaries in Tennessee.

 


Golden Life Healthcare LLC (Sacramento, CA)

Golden Life Healthcare LLC, located in Sacramento, California, is comprised of networks of individual ACO practices and partnerships between hospitals and ACO professionals, with 57 physicians. It will serve Medicare beneficiaries in California.

 


Harbor Medical Associates PC (South Weymouth, MA)

Harbor Medical Associates, PC, located in South Weymouth, Massachusetts, is comprised of ACO group practices, with 116 physicians. It will serve Medicare beneficiaries in Massachusetts.

 


Maryland Accountable Care Organization of Eastern Shore, LLC (National Harbor, MD)

Maryland Accountable Care Organization of Eastern Shore LLC, located in National Harbor, Maryland, is comprised of ACO group practices, networks of individual ACO practices, with 61 physicians. It will serve Medicare beneficiaries in Maryland.

 


Maryland Accountable Care Organization of Western Maryland (National Harbor, MD)

Maryland Accountable Care Organization of Western MD LLC, located in National Harbor, Maryland, is comprised of ACO group practices and networks of individual ACO practices, with 23 physicians. It will serve Medicare beneficiaries in Maryland, Pennsylvania, and West Virginia.

 


Medical Mall Services of Mississippi (Jackson, MS)

Medical Mall Services of Mississippi, located in Jackson, Mississippi, is comprised of networks of individual ACO practices and a federally qualified health center, with 487 physicians. It will serve Medicare beneficiaries in Mississippi.

 


MPS ACO Physicians, LLC (Middletown, CT)

MPS ACO Physicians, LLC, located in Middletown, Connecticut, is comprised of networks of individual ACO practices, with 38 physicians. It will serve Medicare beneficiaries in Connecticut.

 


Physicians ACO, LLC (Houston, TX)

Physicians ACO, LLC, located in Houston, Texas, is comprised of networks of individual ACO practices, with 75 physicians. It will serve Medicare beneficiaries in Texas.

 


PriMed, LLC (Shelton, CT)

PriMed, LLC, located in Shelton, Connecticut, is comprised of ACO group practices, with 116 physicians. It will serve Medicare beneficiaries in Connecticut.

 


Quality Independent Physicians, LLC (Louisville, KY)

Quality Independent Physicians, located in Louisville, Kentucky, is comprised of ACO group practices, with 74 physicians. It will serve Medicare beneficiaries in Indiana and Kentucky.

 


Reliance Healthcare Management Solutions (Tampa, FL)

Reliance Healthcare Management Solutions, LLC, located in Tampa, Florida, is comprised of networks of individual ACO practices, with 36 physicians. It will serve Medicare beneficiaries in Florida.

 


St. Thomas Medical Group, PLLC (Nashville, TN)

St. Thomas Medical Group PLLC, located in Nashville, Tennessee, is comprised of ACO group practices, with 41 physicians. It will serve Medicare beneficiaries in Tennessee.

 


Texoma ACO, LLC (Wichita Falls, TX)

Texoma ACO, LLC, located in Wichita Falls, Texas is comprised of ACO group practices and networks of individual ACO practices, with 52 physicians. It will serve Medicare beneficiaries in Texas.

 

The following Advance Payment ACOs were announced for the performance period that began on January 10, 2013:

American Health Alliance (Ocala, FL)
American Health Network of Ohio PC (Indianapolis, IN)
Central Florida Physicians Trust (Winter Park, FL)
Fort Smith Physicians Alliance ACO (Fort Smith, AR)
KCMPA (Kansas City, MO)
Lower Shore ACO LLC (National Harbor, MD)
National ACO (Beverly Hills, CA)
Nature Coast ACO, LLC (Beverly Hills, FL)
Northeast Florida Accountable Care (Jacksonville, FL)
NOMS ACO, LLC (Sandusky, OH)
Owensboro ACO (Owensboro, KY)
Physicians Collaborative Trust (Maitland, FL)
Primary Partners (Clermont, FL)
Rio Grande Valley Health Alliance (McAllen, TX)
SERPA-ACO (Crete, NE)

 

Background

In developing the Advance Payment ACO Model, CMS is responding to input from stakeholders received on the proposed rule for the Shared Savings Program, and comments received (PDF) on the initial Advance Payment Model announced in May 2011. Some providers have expressed a concern about their lack of ready access to the capital needed to invest in infrastructure and staff for care coordination. The Advance Payment ACO Model is meant to help smaller ACOs with less access to capital participate in the Shared Savings Program.

Initiative Details

Through the Advance Payment ACO Model, selected organizations will receive an advance on the shared savings they are expected to earn. Participating ACOs will receive three types of payments:

  • An upfront, fixed payment: Each ACO will receive a fixed payment.
  • An upfront, variable payment: Each ACO will receive a payment based on the number of its historically-assigned beneficiaries.
  • A monthly payment of varying amount depending on the size of the ACO: Each ACO will receive a monthly payment based on the number of its historically-assigned beneficiaries.

Advance payments are structured in this manner to acknowledge that new ACOs will have both fixed and variable start-up costs.

 

Additional Information

Questions about the Advance Payment application, or the Advance Payment Model generally, can be sent to advpayaco@cms.hhs.gov.



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