CMS: Integra, Lifespan Health Alliance participating in ACO models to improve health care delivery

(Updated 12:18 and 3:48 p.m.)
PROVIDENCE – Integra Community Care Network LLC and Lifespan Health Alliance each are participating in specific Accountable Care Organization models through the Centers for Medicare & Medicaid, according to the organizations.

The Lifespan Health Alliance will cover 18,737 people with 1,700 providers.
Lifespan Health Alliance – a joint-venture partnership between Lifespan and Community Physician Partners, Inc. – was selected as one of 99 new Shared Savings Program ACOs, providing Medicare beneficiaries with access to high-quality, coordinated care across the country. As of Jan. 1, a total of 480 Shared Savings Program ACOs are serving more than 9 million assigned beneficiaries, according to a news release from Lifespan.

Integra began participating in the Next Generation Accountable Care Organization Model through the federal agency also on Jan. 1, according to a Thursday news release from Care New England. An Integra spokesman said approximately 19,800 are participating in the NextGen ACO.

A total of 45 ACOs around the country are participating in the Next Generation model, according to the CMS website. Next Generation ACOs that meet quality standards and reduce total health care spending will share in the savings achieved for the Medicare program, the news release from CNE said.

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The Next Generation ACO Model is described on the CMS website as “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 (models). The goal … 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 patients.

“We are excited about the opportunity presented by this initiative,” Integra Chief Clinical Officer Dr. James E. Fanale said in a statement. “With increased flexibility and improved alignment between payment and care-delivery reform, we believe we can build on the early success of Integra and deliver even better and more efficient health care.”

Integra also has been participating in CMS’ payment and delivery reform as a certified Medicare Shared Savings Program with approximately 19,000 Medicare beneficiaries, according to CNE.

Integra’s participating provider network includes the Rhode Island Primary Care Physician Corp., Care New England Health System, South County Health System and their employed and affiliated physicians.

Patients that see NGACO participants and preferred providers will see no changes to their original Medicare benefits, and maintain their ability to see any Medicare provider.

The CMS website describes Medicare ACOs as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to provide coordinated, high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.”

CMS this week said more than 359,000 clinicians are confirmed to participate in four of CMS’ Alternative Payment Models in 2017. Clinicians who participate in APMs are paid for the quality of care they give to their patients.

In addition to the Next Generation and Shared Savings Program, the two other models announced were Comprehensive End-Stage Renal Disease Care Model and Comprehensive Primary Care Plus Model; all apply the concept of paying for quality and effectiveness of care given to patients in different health care settings.

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