Advance Payment ACO Model

Recent Updates:

04/10 - Participants announced for the performance period beginning April 1, 2012.
01/06 - A recording of the Advance Payment Model "Application Process" Open Door Forum will be available on the Webinars & Forums page shortly.

Overview

The Advance Payment Model is designed to provide support to organizations whose ability to improve care and lower costs would be improved with additional access to capital. Some providers have expressed a concern about their lack of ready access to the capital needed to invest in infrastructure and staff for care coordination. Through the Advance Payment Model, selected organizations will receive an advance on the shared savings they are expected to earn.

Background

As a complement to CMS’ Medicare Shared Savings Program, the Innovation Center is sponsoring the Advance Payment ACO Model to test whether and how pre-paying a portion of future shared savings could increase participation in the Medicare Shared Savings Program. Increasing participation in the Medicare Shared Savings Program may also increase the amount of and speed at which ACOs can improve care for beneficiaries and generate Medicare savings.

In developing the Advance Payment ACO Model, CMS is responding to comments received on the proposed rule for the Shared Savings Program, and comments received (PDF) on the Advance Payment Model announced in May 2011.

Payment Details

Some providers have expressed a concern about their lack of ready access to the capital needed to invest in infrastructure and staff for care coordination. Through the Advance Payment Model, selected organizations will receive an advance on the shared savings they are expected to earn.

Under the Advance Payment ACO Model, participating ACOs will receive three types of payments:

An upfront, fixed payment: Each ACO will receive a fixed payment.
An upfront, variable payment: Each ACO will receive a payment based on the number of its historically-assigned beneficiaries.
A monthly payment of varying amount depending on the size of the ACO: Each ACO will receive a monthly payment based on the number of its historically-assigned beneficiaries.

Advance payments are structured in this manner to acknowledge that new ACOs will have both fixed and variable start-up costs.

The Advance Payment ACOs

On April 10, 2012 CMS announced the organizations participating in the Advance Payment Model beginning April 1, 2012. The organizations are listed below:

Coastal Carolina Quality Care, Inc (New Bern, NC)
Jackson Purchase Medical Associates, PSC (Paducah, KY)
North Country ACO (Littleton, NH)
Primary Partners, LLC (Clermont, FL)
RGV ACO Health Providers, LLC (Donna, TX)

Organizations participating in the Advance Payment Model beginning July 1, 2012 will be announced in coming months.

Eligibility

Only ACOs that enter the Medicare Shared Savings Program in April 2012 or July 2012 are eligible. Organizations interested in participating in the Advance Payment Model were required to apply to both the Medicare Shared Savings Program and Advance Payment Model.

The Advance Payment ACO Model is open only to two types of organizations:

ACOs that do not include any inpatient facilities AND have less than $50 million in total annual revenue.
ACOs in which the only inpatient facilities are critical access hospitals and/or Medicare low-volume rural hospitals AND have less than $80 million in total annual revenue.

Additional Information

Questions about the Advance Payment application, or the Advance Payment Model generally, can be sent to advpayaco@cms.hhs.gov.