With a refreshed menu of Medicare payment models, CMS has now directly answered the question that’s been on the collective minds of all ACOs (and vendors) for a couple of years: What will be the way of the future in population health?

What’s new with Medicare ACOs?

CMS overhauled the Medicare Shared Savings Program in December, re-branding it as “Pathways to Success”, and then followed by announcing its most progressive population-based payment models yet: Primary Care First and Direct Contracting. Together, these payment models represent a bold step forward in incentivizing better clinical outcomes and lowered costs. The models show that CMS sees population-based payment as the key “pathway” to “success”. Perhaps more significantly, these new models clearly demonstrate that CMS’ imperative to curb Medicare spending transcends any incumbent political administration.

The introduction of these new payment models should, therefore, be raising near-term questions for all Medicare ACOs:

How should I participate in Medicare ACOs?

  • What are the payment models, and how have they changed from previous offerings?
  • How should I position my ACO for success in this new risk-based savings and payment environment?
  • What participation options are best for my ACO?

How should I prepare?

  • What challenges that I have faced in the past could impact my success?
  • Whose care, exactly, will I be responsible for in the payment models?
  • Who of my population should I begin to engage in population health initiatives such as care management?

How can I succeed?

  • What capabilities do I need to assemble to succeed in a payment model, and what is my likely ROI for these capabilities?
  • How can I gain an edge with high-confidence information and intelligence that can answer all of the above?

Clarify Health works with leading organizations to power higher-value healthcare. Learn more about our value-based care products here.

This article was originally posted in August 2019 and updated in August 2020. 

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