Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program (Shared Savings Program), the Next Generation ACO Model offers a new opportunity in accountable care—one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.
There are 44 ACOs participating in the Next Generation ACO Model. (List)To view an interactive map of this Model, visit the Where Innovation is Happening page. expand Read more about
If you are a Medicare beneficiary seeking information about this model, please review the section below titled I'm a Medicare Beneficiary, so what does this mean for me?
Medicare ACOs are comprised of groups of doctors, hospitals, and other health care providers and suppliers who come together voluntarily to provide coordinated, high-quality care at lower costs to their Original Medicare patients. ACOs are patient-centered organizations where the patient and providers are true partners in care decisions. Medicare beneficiaries will have better control over their health care, and providers will have better information about their patients’ medical history and better relationships with patients’ other providers. Provider participation in ACOs is purely voluntary, and participating patients will see no change in their Original Medicare benefits and will keep their freedom to see any Medicare provider. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.
The Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients. It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP). The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.
Included in the Next Generation ACO Model are strong patient protections to ensure that patients have access to and receive high-quality care. Like other Medicare ACO initiatives, this Model will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures. This is in accordance with the Department of Health and Human Services’ “Better, Smarter, Healthier” approach to improving our nation’s health care and setting clear, measurable goals and a timeline to move the Medicare program -- and the health care system at large -- toward paying providers based on the quality rather than the quantity of care they provide to patients. In addition, CMS will publicly report the performance of the Next Generation Pioneer ACOs on quality metrics, including patient experience ratings, on its website.
Quality and financial results are provided for Performance Year 1 (2016):
The Model will consist of three initial performance years and two optional one-year extensions. Specific eligibility criteria are outlined in the Request for Applications (PDF). Questions regarding the Next Generation ACO Model can be directed to NextGenerationACOModel@cms.hhs.gov.
Benefit enhancements are waivers of certain Medicare service rules (i.e., telehealth, post-discharge home visits, and the three-day skilled nursing facility rule), and initiatives intended to assist Next Generation Accountable Care Organizations in improving care for and engagement of their beneficiaries.
- Telehealth Expansion Waiver (PDF)
- Post-Discharge Home Visit Waiver (PDF)
- Three-Day Skilled Nursing Facility Waiver (PDF)
- Voluntary Alignment Frequently Asked Questions (PDF)
- What is the Telehealth waiver? (PDF)
- What is the Post-Discharge Home Visit waiver? (PDF)
- What is the Three-Day Skilled Nursing Facility Waiver? (PDF)
- Voluntary Alignment Frequently Asked Questions for beneficiaries & caregivers (PDF)
- Coordinated Care Reward Frequently Asked Questions (PDF)
- Next Generation ACO Model Benchmark Methodology for Performance Years 1-3 (PDF)
- Next Generation ACO Model Financial and Quality Results Performance Year 1 (XLS)
- Fact Sheet
- Press Release
- Frequently Asked Questions (PDF)
- Financial & Alignment Frequently Asked Questions
- Next Generation ACO & Pioneer ACO Comparison Table (PDF)
- Archived Materials