December, 2018 Update:

The national program for ACOs in Medicare has been in operation for six years, and over time CMS has learned from these experiences. Building on this experience, Pathways to Success overhauls the current program to put true accountability in Accountable Care Organizations and promote program-wide savings for Medicare’s ACOs.

Pathways to Success implements bold changes including:

  • Accountability and Competition: The final rule reduces the amount of time that an ACO can remain in the program without taking accountability for healthcare spending from six years to two years for new ACOs and three years for new “low revenue” (physician-led) ACOs, including some rural ACOs. The rule also strengthens incentives by providing higher shared savings rates as ACOs transition and accept greater levels of risk.
  • Quality: To increase flexibility for ACOs taking on risk, Pathways to Success expands access to high-quality telehealth services that are convenient for patients, including telehealth services provided at a patient’s place of residence.
  • Beneficiary Engagement: Pathways to Success promotes beneficiary engagement and improved health outcomes by allowing ACOs to offer new incentive payments to beneficiaries for taking steps to achieve good health, such as obtaining primary care services and necessary follow-up care. In addition, this rule requires ACOs to provide beneficiaries with a written explanation in person or via email or patient portal of what it means to be in an ACO to put patients in the driver seat.
  • Integrity: This rule establishes rigorous benchmarks by incorporating factors from regional Medicare spending to establish an ACO’s benchmark during all agreement periods, providing a more accurate point of comparison for evaluating ACO performance. In addition, ACOs that terminate their participation will be accountable for prorated shared losses.

In addition to the larger program in Medicare for ACOs that today’s rule will impact, CMS is releasing the financial and quality results for the second performance year of the Next Generation ACO Model. The Next Generation model requires participants to assume the highest level of risk out of all CMS ACO programs, and in exchange for this level of risk, Next Generation ACOs receive greater regulatory flexibility. The Next Generation ACO Model actuarial results show that net savings to the Medicare Trust Funds from the model in 2017 were more than $164 million across 44 ACOs. The Model is also showing strong performance on quality metrics.

In connection with the Medicare Shared Savings Program redesign, CMS will offer an application cycle for a special one-time new ACO agreement period start date of July 1, 2019. Ninety percent of eligible ACOs with participation agreements expiring on December 31, 2018 have elected to extend their agreement for six months, so they have the option to renew their agreement under the new policies and continue to participate in the program uninterrupted. The Notice of Intent to Apply will be available January 2, 2019 through January 18, 2019. The application submission due dates will be posted on the Medicare Shared Savings Program website in the coming days. See the Application Types & Process webpage for eligibility requirements, key timelines, and detailed instructions on the submission process.

Additional Information: 

What is an ACO?

ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.

The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.

Where can I learn more about ACOs?

CMS offers different learning opportunities for providers and organizations interested in learning more about ACOs. Visit the CMS Innovation Center website and Medicare Shared Savings Program website periodically to learn about the latest opportunities.

Visit the Medicare fee-for-service Frequently Asked Questions for more information on the Medicare Shared Savings Program.

Background on the Shared Savings Program:

On April 10, 2012, CMS announced the selection of the first 27 accountable care organizations (ACOs) to participate in the Medicare Shared Saving Program (Shared Savings Program). The selected organizations have agreed to be responsible for improving care for nearly 375,000 beneficiaries in eighteen states through better coordination among providers. All ACOs that succeed in providing high quality care – as measured by performance on 33 quality measures relating to care coordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations, and the patient experience of care – while reducing the costs of care – may share in the savings to Medicare.

Section 3022 of the Affordable Care Act added a new section 1899 to the Social Security Act that requires the Secretary to establish the Shared Savings Program. The program is intended to encourage providers of Medicare-covered services and supplies (e.g., physicians, hospitals and others involved in patient care) to create a new type of health care entity, an ACO, that agrees to be held accountable for improving the health and experience of care for individuals and improving the health of populations while reducing the rate of growth in health care spending. Studies have shown that better care often costs less, because coordinated care helps to ensure that the patient receives the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors.

On Nov. 2, 2011, CMS published a final rule in the Federal Register establishing the Shared Savings Program. The final rule addressed issues relating to eligibility, governance, beneficiary rights, quality measures and performance scoring, and CMS monitoring of the ACO operations. At the same time, the Innovation Center announced an Advance Payment ACO Model to test whether providing advance payments from anticipated savings could encourage certain rural and physician-based entities to apply to participate in the program, thereby increasing the amount and speed at which ACOs can improve care for beneficiaries and generate Medicare savings.

In conjunction with the final rule, the Department of Health and Human Services Office of Inspector General, the Department of Justice, the Federal Trade Commission, and the Internal Revenue Service issued separate notices addressing a variety of legal issues as they applied to the Shared Savings Program. These included the interaction of the Shared Savings Program with the federal anti-kickback, physician self-referral, civil monetary penalty (the fraud and abuse laws) and antitrust laws, as well as the Internal Revenue Code regarding the tax implications for nonprofit entities seeking to participate in ACOs. The final rule, the notice of the Advance Payment ACO Model, and the regulatory guidance on fraud and abuse were published in the Nov. 2, 2011 Federal Register.

The final rules offered ACOs the option for the first year of the program of starting on either April 1 or July 1, 2012. CMS will announce the date for submission of applications to participate in the Shared Savings Program beginning in 2013 later this year.

2018

New Final Rule published December 31, 2018 in the Federal Register

2017

January 18, 2017 – CMS announced the selection of 99 new Accountable Care Organizations (ACOs) and 79 renewing ACOs that are joining or continuing their participation in the Medicare Shared Savings Program (Shared Savings Program) for the 2017 performance year.The seventh application cycle will grow the Shared Savings Program to 480 participating ACOs beginning January 1, 2017.

Beginning January 1, 2017, Track 3 ACOs are eligible to use the Skilled Nursing Facility (SNF) 3-Day Rule Waiver, which is newly available under the Shared Savings Program regulations. CMS approved 26 Track 3 ACOs, and 425 participating skilled nursing facilities (also referred to as SNF affiliates), to use the SNF 3-Day Rule Waiver.

2016

December 20, 2016 – CMS announced a new Innovation Center model, the Medicare ACO Track 1+ Model, beginning in 2018, that will test a payment design that incorporates more limited downside risk than is currently present in Tracks 2 or 3 of the Shared Savings Program in order to encourage more rapid progression to performance-based risk by Track 1 ACOs.

August 25, 2016 – CMS announced the Performance Year (PY) 2015 financial and quality performance results for 392 ACOs with 2012, 2013, 2014 and 2015 agreement start dates, and posted related data on the Data.CMS.gov website. This is the first performance year for ACOs with a 2015 start date, the second for ACOs with a 2014 start date and the third for ACOs with a 2012 or 2013 start date.

June 6, 2016 – CMS issued a final rule that incorporates regional fee-for-service expenditures into the methodology for establishing, adjusting, and updating the benchmarks of ACOs that renew their participation in the Shared Savings Program; adds a participation option to encourage ACOs to transition to performance-based risk arrangements; and provides greater administrative finality around the program’s financial calculations.

March 3, 2016 – Medicare Shared Savings Program Listening Session: Proposed Rule on Revised Benchmark Rebasing Methodology.

This listening session is an opportunity for CMS to receive early feedback from stakeholders on proposed policy changes to the Medicare Shared Savings Program. Participants are encouraged to review the proposed rule (CMS-1644-P) prior to the listening session. Feedback received during the listening session will not be considered formal comments on the rule. See the proposed rule for information on submitting these comments by the close of the 60-day comment period on March 28, 2016 at 5 pm ET. Call details are available on the 2016-03-03 call web page.

January 28, 2016 – CMS released a new proposed rule (CMS-1644-P) focused on incorporating regional fee-for-service expenditures into the methodology for establishing, adjusting and updating an ACO’s historical benchmark for its second or subsequent agreement period. CMS has made publicly available additional data files to facilitate ACOs and other stakeholders in modeling the proposed changes to the benchmark rebasing methodology, in combination with other publicly available programmatic data. The proposed rule includes proposed modifications to streamline the methodology used for adjusting the ACO’s benchmark for composition changes, encourage ACOs to transition to participating under a performance-based risk arrangement and addresses administrative finality around the program’s financial calculations. You can view the proposed rule at:  https://www.federalregister.gov. There will be a 60-day public comment period on this proposed rule, closing March 28, 2016, at 5 p.m. Eastern Time.

January 11, 2016 – CMS announced that 100 new ACOs and 147 renewing ACOs were accepted in to the Shared Savings Program effective January 1, 2016. The sixth application cycle will grow the Shared Savings Program to 434 participating ACOs beginning January 1, 2016.

2015

August 25, 2015 – CMS announced the Performance Year 2014 financial reconciliation and quality performance results for 333 ACOs with 2012, 2013, and 2014 agreement start dates, and posted related data on the Data.CMS.gov website. This is the first performance year for ACOs with 2014 start dates and the second performance year for ACOs with 2012 and 2013 start dates.  Quality performance for an ACO’s first performance year is defined as complete and accurate reporting of all required quality measures. Pay for performance on quality measures is phased-in over the ACO’s second and third performance years.

June 9, 2015 – CMS published a final rule to strengthen the Shared Savings Program for ACOs. The rule changes several program areas including beneficiary assignment, data sharing, available performance risk models, eligibility requirements, participation agreement renewals, and compliance and monitoring.

2014

December 22, 2014 – CMS announced that 89 new organizations have been selected to participate in the Shared Savings Program. The fifth cycle begins January 1, 2015.

December 1, 2014 – CMS released a new proposal to strengthen the Shared Savings Program for ACOs. The rule proposes changes to several program areas including beneficiary assignment, data sharing, available performance risk models, eligibility requirements, participation agreement renewals, and compliance and monitoring. The proposed rule reflects input from program participants, experts, consumer groups, and the stakeholder community at large. You can view the proposed rule at: https://www.federalregister.gov/articles/2014/12/08/2014-28388/medicare-program-medicare-shared-savings-program-accountable-care-organizations. The 60-day comment period closed February 6, 2015, at 5 p.m. Eastern Time.

November 7, 2014 – CMS has posted the Performance Year 1 final financial reconciliation and quality performance results for all ACOs with 2012 and 2013 agreement start dates data on the Data.CMS.gov website. You can view the data at https://data.cms.gov/ACO/Medicare-Shared-Savings-Program-Accountable-Care-O/yuq5-65xt.

September 22, 2014 – CMS announced the Performance Year 1 quality performance results for ACOs with 2012 and 2013 agreement start dates. For the first Performance Year, CMS defined the quality performance standard at the level of complete and accurate reporting for all quality measures. In Performance Year 1, 209 ACOs met the quality performance standard and were eligible to share in savings, if earned. Quality performance for Performance Year 1 reconciliation for ACOs with 2012 start dates is based on complete and accurate reporting of all required quality measures for Calendar Years 2012 and 2013. Quality performance for Performance Year 1 reconciliation for ACOs with 2013 start dates is based on complete and accurate reporting of all required quality measures for Calendar Year 2013. The quality performance results provided in the Performance Year 1 announcement reflect Calendar Year 2013 performance rates for 220 ACOs. The Calendar Year 2013 mean quality performance rate for each measure, across all ACOs, is also provided.

September 16, 2014 – CMS announced Performance Year 1 FINAL financial reconciliation and quality performance results for ACOs with 2012 and 2013 agreement start dates. Fifty-three ACOs with 2012 and 2013 start dates generated shared savings during their first performance year; performance year 1 is a 21- or 18-month period for ACOs with 2012 start dates, and a 12 month period for ACOs with 2013 start dates. ACOs that generated savings earned a performance payment if they met the quality standard. One Track 2 ACO with shared losses must repay CMS. This table will be updated soon with additional details. For more information, see the Department of Health & Human Services (HHS) press release and fact sheet.

January 30, 2014—CMS announced Performance Year 1 INTERIM financial reconciliation results for ACOs that started in April and July 2012. Thirty-one ACOs that started in the Shared Savings Program in April or July 2012 generated shared savings or losses during their first 12 months of participation. We will complete the FINAL Performance Year 1(PY1) reconciliation later this year on all ACOs that started in 2012 and 2013. Consequently, an ACO’s final performance results may differ from their interim results. ACOs that earned a performance payment were eligible for interim payment because they met the quality standard, elected the interim payment option in their application, and posted the required repayment mechanism. A Track 2 ACO with shared losses must repay CMS based on interim PY1 reconciliation if it elected the interim payment option in its application and posted the required repayment mechanism.

2013

December 23, 2013—CMS announced that 123 new organizations have been selected to participate in the Shared Savings Program. The fourth cycle begins January 1, 2014.

January 10, 2013—CMS announced that 106 new organizations have been selected to participate in the Shared Savings Program. The third cycle began on January 1, 2013.

2012

July 9, 2012—CMS announced that 87 new organizations have been selected to participate in the Shared Savings Program. The second cycle began on July 1, 2012.

April 10, 2012—CMS announced that 27 organizations have been selected to participate in the Shared Savings Program. The first cycle began on April 1, 2012.

2011

November 10, 2011 – Making Good on ACOs’ Promise — The Final Rule for the Medicare Shared Savings Program – Donald M. Berwick, M.D. from the New England Journal of Medicine.

October 20, 2011 – HHS Announces New Incentives for Providers to Work Together Through Accountable Care Organizations When Caring for People with Medicare

More information about all ACO initiatives at CMS can be found at:

http://www.cms.gov/aco

More information about the Shared Savings Program can be found at:

http://www.cms.hhs.gov/sharedsavingsprogram/

More information about the Advance Payment ACO Model can be found at:

https://innovation.cms.gov/initiatives/Advance-Payment-ACO-Model/

Links to the statute, regulations, and guidance regarding the final rule, including the guidance issued by the federal agencies listed above can be found at:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Statutes-Regulations-Guidance.html

APPENDIX

SUMMARIES OF ACOS SELECTED FOR APRIL 1, 2012 START-UP

Accountable Care Organization/Collaborative Health Systems Partnerships

The following Accountable Care Organizations (ACOs), which will serve beneficiaries in eight states, are partnerships between local health care providers and Collaborative Health Systems (CHS), which will provide a range of care coordination, analytics and reporting, technology and other administrative services to enable physicians and other healthcare professionals to deliver quality healthcare efficiently. This collaboration is designed to achieve the CMS goal of the three part aim objectives of better overall care, improved health and lower per capita costs for Medicare Fee-for Service beneficiaries attributed to the ACO

Accountable Care Coalition of Caldwell County, LLC
The Accountable Care Coalition of Caldwell County, LLC is an ACO formed in partnership between Caldwell Memorial Hospital, Inc. and CHS. Caldwell Memorial Hospital, which opened in 1951, serves the people of Caldwell County, NC, and represents more than 50 provider practitioners, serving more than 5,000 Medicare beneficiaries.

Accountable Care Coalition of Coastal Georgia
The Accountable Care Coalition of Coastal Georgia is an ACO formed in partnership between South Coast Medical Group, LLC and CHS. It will serve approximately 8,000 beneficiaries in the Savannah, Georgia, area.

Accountable Care Coalition of Eastern North Carolina, LLC
The Accountable Care Coalition of Eastern North Carolina, LLC is an ACO formed in partnership between The Atlantic Integrated Health Network (AIHN) and CHS. AIHN, which was founded in 1994 and now includes more than 6,400 physicians and other health care providers, is one of the oldest self-sustaining physician-led networks in North Carolina. It is expected to serve nearly 10,000 beneficiaries.

Accountable Care Coalition of Greater Athens Georgia
The Accountable Care Coalition of Greater Athens Georgia is an ACO formed in partnership between the Coalition of Athens Area Physicians, Inc. and CHS. It is expected to serve approximately 8,500 beneficiaries.

Accountable Care Coalition of Mount Kisco, LLC
The Accountable Care Coalition of Mount Kisco, LLC is an ACO formed in partnership between Mount Kisco Medical Group, PC, and CHS. Mount Kisco Medical Group is a multi-specialty medical provider that offers medical care to patients at 25 locations. It is comprised of more than 270 physicians representing 40 different medical specialties throughout the Mount Kisco, New York area.

Accountable Care Coalition of the Mississippi Gulf Coast, LLC
The Accountable Care Coalition of the Mississippi Gulf Coast, LLC is an ACO formed in partnership between Mississippi Coast Physicians, Inc. and CHS. It is expected to serve nearly 7,000 beneficiaries.

Accountable Care Coalition of the North Country, LLC
The Accountable Care Coalition of the North Country, LLC is an ACO formed in partnership between North Country Physicians Organization, PLLC (NCPO) and CHS. NCPO is a multi-specialty medical provider that offers the medical care to patients at various locations in New York, including Potsdam, Canton, Massena, Ogdensburg, Gouverneur, and Malone. It is comprised of more than 170 physicians representing 30 different medical specialties. It is expected to serve about 5,300 beneficiaries.

Accountable Care Coalition of Southeast Wisconsin, LLC
The Accountable Care Coalition of Southeast Wisconsin, LLC is an ACO formed in partnership between Independent Physician Network, Inc. (IPN) and CHS. IPN was established in 1984 and has grown to include more than 900 member physicians who serve more than 130,000 patients in southeastern Wisconsin. The ACO is expected to serve nearly 10,000 beneficiaries.

Accountable Care Coalition of Texas, Inc.
The Accountable Care Coalition of Texas, Inc. is an ACO created through a partnership between an affiliation of Independent Physician Associations, medical groups and health systems in the Houston/Beaumont area of Texas and CHS. The founders of Accountable Care Coalition of Texas, Inc. have a long history of working together collaboratively to deliver quality care efficiently. Their care coordination approach helps physicians give the right care at the right time to Medicare patients, especially the chronically ill, and reduce unnecessary services. The ACO is expected to serve nearly 70,000 beneficiaries.

AHS ACO, LLC

The Atlantic ACO includes a partnership with The Valley Hospital in Ridgewood, NJ, and participation from more than 1,300 physicians, including more than 200 primary care physicians, 50 nurse practitioners and 10 ancillary care providers in five regions: Bergen, Morris, Somerset, Sussex, and Union counties. Through its participating physicians, hospitals, and staff, Atlantic ACO is committed to improving the quality of health care and reducing the individual and clinical health care costs for the Medicare population served in these regions. Atlantic Health System includes Morristown, Overlook, and Newton medical centers and Goryeb Children’s Hospital. Atlantic ACO will care for nearly 50,000 beneficiaries.

AppleCare Medical ACO, LLC

AppleCare Medical ACO is a network of physicians that provide care to patients throughout Southern Los Angeles County and Orange County. Owned and managed by physicians, AppleCare Medical ACO partners with more than 800 physicians in the region, as well as major hospitals and medical centers across Southern California to provide access to a full spectrum of facilities for receiving whatever care a patient may require. AppleCare Medical ACO is affiliated with AppleCare Medical Group. The ACO is expected to serve nearly 8,000 beneficiaries.

Arizona Connected Care, LLC

Arizona Connected Care is a collaboration of independent health care providers in Tucson and Southern Arizona, including more than 150 physicians, three Federally Qualified Health Centers and Tucson Medical Center. While building on Patient-Centered Medical Home methods to improve access to team-based primary care services, Arizona Connected Care is also committed to aligning efforts of specialists and institutions to assure that patients throughout the community have access to necessary services, in a supportive and education-based health care environment. Engaging patients directly in their own care should lead to improved decision-making, quality of life and better use of community health resources. Arizona Connected Care will re- focus on basics, providing patients with access to information and extra resources to assist with transitions between care settings – “hospital to home”, ensuring that patients (especially those with chronic conditions) get the right care, at the right time, in the right setting. The ACO is expected to serve nearly 7,500 beneficiaries.

Chinese Community Accountable Care Organization

The Chinese Community ACO will operate in New York City’s Chinese community and will focus its efforts on providing culturally competent care to its patients while improving their healthcare and reducing costs. This collaboration of physicians with expertise in caring for this underserved, minority population with special considerations will work with its community partners, hospitals (e.g. Beth Israel Medical Center, New York Hospital Queens, Lutheran Medical Center and Flushing Hospital), visiting nurse service agencies, home care service agencies, churches, senior centers, and senior social day care centers, etc. It will engage patients and their families to participate in their care plans and disease management. The ACO is expected to serve nearly 12,000 beneficiaries.

CIPA Western New York IPA, doing business as Catholic Medical Partners

Located in Buffalo, NY, Catholic Medical Partners is a network of more than 900 independent practicing physicians, Catholic Health and Mount St. Mary Hospital dedicated to serving the people of Erie and Niagara counties. Through the development and implementation of clinical integration programs, Catholic Medical Partners and its providers are focused on improving the efficiency, safety and quality in delivering medical care based on coordination, an educated and involved patient population and the sharing of information and resources that will make a difference in patients’ lives. The ACO is expected to serve more than 31,000 beneficiaries.

Coastal Carolina Quality Care, Inc.

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.

Crystal Run Healthcare ACO, LLC

Crystal Run Healthcare is a multi-specialty group with over 200 providers, in over 40 medical specialties with 15 practice locations. Its treatment decisions are based on nationally accepted, evidenced –based guidelines. It is expected to serve nearly 10,000 beneficiaries in New York and Pennsylvania.

Florida Physicians Trust, LLC

Florida Physicians Trust, LLC represents a diverse group of independent physicians, including both Doctors of Medicine and Doctors of Osteopathic Medicine, who have jointly created a patient-centric approach to providing quality service across the entire spectrum of care for beneficiaries in Florida. The ACO will provide care coordination, stressing communication, medical information exchange, and team based care among primary care physicians and specialists. The ACO is expected to serve about 16,500 beneficiaries.

Hackensack Physician-Hospital Alliance ACO, LLC

HackensackUMC, a non-profit teaching and research hospital located in Bergen County, New Jersey, is the largest provider of inpatient and outpatient services in the state. This 775-bed facility provides a broad spectrum of care in a number of facilities, including the Heart & Vascular Hospital, the John Theurer Cancer Center, the Joseph M. Sanzari Children’s Hospital, and the Donna A. Sanzari Women’s Hospital. The ACO is expected to serve approximately 11,000 beneficiaries.

Jackson Purchase Medical Associates, PSC

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.

Jordan Community ACO

The Jordan Community ACO is a not-for-profit organization based in Plymouth, Massachusetts and founded in 2012. The Jordan Community ACO consists of more than 100 physicians from Plymouth Bay Medical Associates, Jordan Physician Associates, and a number of specialty physicians from Jordan Hospital. Together, the Jordan Community ACO physicians coordinate the healthcare of more than 6,000 Medicare beneficiaries in Plymouth and Barnstable Counties. This approach ensures that patients receive the right care from the right provider at the right time, making it possible to identify and address problems early, before hospital care becomes necessary.

North Country ACO

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.

Optimus Healthcare Partners, LLC

Optimus Healthcare Partners, LLC, located in Summit, New Jersey, is a physician-governed ACO comprised of over 500 primary and specialty physicians working closely together to serve patients in the following New Jersey counties: Bergen, Essex, Hudson, Hunterdon, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, and Union. Optimus is dedicated to improving the quality of care for its patients through patient centered models of care, promoting evidence based medicine, improved outcomes, and enhancing our patients’ experience and satisfaction. The most important innovation Optimus provides is “clarity and culture”; putting the patient first, rebuilding the healthcare system’s culture of compassion, and then applying an accountable framework that drives quality and affordability. The ACO is expected to serve nearly 29,000 beneficiaries.

Physicians of Cape Cod ACO Description of Organization

Physicians of Cape Cod ACO has been coordinating care for beneficiaries through a managed care program for 10 years, and intends to bring the expertise developed in that program to the ACO model for fee-for-service beneficiaries. It is expected to serve approximately 5,000 beneficiaries living in Cape Cod, Massachusetts.

Premier ACO Physician Network

Premier ACO Physicians Network is a subsidiary of Lakewood IPA, which has more than 25 years of experience in providing and managing capitated health care services to patients in the Greater Long Beach and Orange County areas. The physicians of Premier ACO, who also serve patients of the IPAs, will bring the expertise they have developed in the capitated health care context to care coordination in Medicare’s fee-for-services program. The ACO is expected to serve about 12,500 beneficiaries.

Primary Partners, LLC

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

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.

West Florida ACO, LLC

West Florida ACO, LLC (ACO) is comprised of over 30 participating primary care physicians and specialists. The ACO will focus on coordination of care and quality programs geared towards the geriatric population. The ACO leadership has substantial experience with quality of care and efficiency improvement initiatives, including, but not limited to, service as medical directors, clinical oversight directors and clinical co-management program directors. The ACO is expected to serve more than 10,000 beneficiaries.

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