How physicians can decide if new ACOs are right for them

Despite the improvements, the new Next Generation ACOs still may not be the right fit for every organization. 

Organizations who are newer to value-based care models may find MSSPs to be a good starting place, notes Danielle Mahaffey, MD, chief medical officer at CHESS, an organization that helps physicians transition to value-based models. CHESS operates a Next Generation ACO for Cornerstone Health Care, a multispecialty physician group based in High Point, North Carolina, and an MSSP for some other physician groups. 

“MSSP allows the security of upside risk only,” explains Mahaffey. “It protects groups as they are just starting to do the work in value-based healthcare.” 

Some experienced MSSPs also are balking at moving up to the Next Generation Model. Farzad Mostashari, MD, co-founder and CEO of Aledade, an organization that partners with primary care physicians to create ACOs, and past head of the Office of the National Coordinator for Health Information Technology, explains that the recently updated benchmarks for MSSP factor in three years of past performance and regional competitors’ costs. As currently described, the Next Generation benchmark would only look at their most recent year. So organizations that have already reduced costs would have to “beat their personal best over and over again,” Mostashari explains. For them, it would be better to stick with the MSSP, which all of the ACOs Aledade works with have opted to do.

“It’s a no brainer, of course, I’m not going to go to Next Generation,” Mostashari says. “They need to clarify the benchmark [in light of the updated MSSP benchmark].”  

Many large healthcare organizations were largely absent from the list of Next Generation ACOs. Instead, Kavita Patel, MD, a senior fellow at the Brookings Institution, notes that many of the Next Generation ACOs are smaller provider-driven organizations. The larger organizations, she says, may be waiting to see how the new program shapes up, or may already be participating in a Medicare Advantage program.

“They are still trying to figure out if it is worth it,” Patel says. “It might be easier to be an MSSP or do nothing if you are a big system.” 

Still many see the new program as a step forward. Detroit’s Henry Ford Health System decided to take the plunge with the Next Generation ACO after rejecting CMS’ previous models, according to Charles Kelly, DO, president and CEO of the Henry Ford Physicians Network. Henry Ford applied and was accepted to the MSSP program, but backed out after receiving benchmarks. 

“We rejected it because the amount of investment and the payback were a mismatch,” he explains. 

But Kelly says the Next Gen offers tools that will help Henry Ford succeed at boosting its population’s health and sets more fair and transparent benchmarks for success than previous versions. 

“You know what you are getting into when you sign up,” Kelly says. 

More freedom was a big draw for Grace Terrell, MD, MMM, CEO of Cornerstone Health Care, for her organization to move up from the MSSP program too Next Gen. Specifically, she sees the expanded use of telemedicine and home visits in the Next Generation as giving her more flexibility to meet her patient’s needs. Terrell says she also anticipates that CMS will continue to adapting and improving the Next Gen program over time. 

“It’s not going to be perfect, nothing ever is,” Terrell says. “We see it as giving us more degrees of freedom.”