Advance Payment ACO Model

The Advance Payment Model was 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 received upfront and monthly payments, which they could use to make important investments in their care coordination infrastructure.

Select anywhere on the map below to view the interactive version ADV mapped

There were 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.

Background

In developing the Advance Payment ACO Model, CMS responded 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 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 was 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 received an advance on the shared savings they are expected to earn. Participating ACOs received three types of payments:

  • An upfront, fixed payment: Each ACO received a fixed payment.
  • An upfront, variable payment: Each ACO received 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 received a monthly payment based on the number of its historically-assigned beneficiaries.

Advance payments were 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.