ADVANTAGECARE ACO: ACPNY’s Participation in Medicare Shared Savings Program (MSSP) ACO

ADVANTAGECARE ACO:
ACPNY's Participation in Medicare Shared Savings Program (MSSP) ACO

Medicare Shared Savings Program (MSSP) ACO gives primary care providers an opportunity to improve care delivery and health outcomes for all patients enrolled in traditional Medicare. Under this program, primary care providers can join or form an ACO that can directly contract with the Centers for Medicare & Medicaid Services (CMS) just like a health plan to improve population health outcomes across local communities.

MSSP is Medicare’s largest value-based payment model. ACOs take accountability for all of their assigned patients’ medical spending over the course of a year. MSSP ACO allows participating ACO providers to share in savings with Medicare if the ACO achieves quality goals and controls spending, which helps with ongoing practice investments to improve access to care and population health across local communities.

Organizational Information

ACO Participants:

AdvantageCare ACO was a participant in MSSP from 2016-2021, and during that time generated over $28 million in total savings for our Medicare population. ACPNY is proud of its track record improving the health and well-being of diverse and often overlooked communities by providing access to affordable and culturally competent primary and specialty care outside hospital systems. ACPNY’s delivery of primary and specialty care in outpatient, community settings prevents unnecessary hospitalizations, improves population health outcomes, and reduces health care disparities.

AdvantageCare ACO hopes to continue its successful MSSP ACO experience in future program years as we continue to provide coordinated, high-quality care at lower costs to our Medicare beneficiaries. Please check back for forthcoming information about AdvantageCare ACO’s quality and financial performance as we rejoined the MSSP ACO program in 2024.

To see a list of the ACPNY providers who are participating in AdvantageCare ACO click here.

Providers who are part of an ACO find that they are able to give their patients better quality care. Medicare benefits for patients seeing an MSSP ACO provider will not be changed. However, as a patient of an MSSP ACO provider, some special features may be available to you at no extra cost. These special features are listed below:

• Coordination of care between specialists, hospitals, nursing homes and care managers
• Provider registry management to determine care opportunities
• Outreach to patients including phone and email to ensure follow-up as allowed under applicable state regulation or state medical licensing requirements; self-management support and counseling; some behavior change management, case management and disease management
• Medication management
• Care plan follow-up
• Outreach and care management for patients with chronic disease

For information about any of these features, please ask your doctor or healthcare provider. Additionally, the Medicare program tracks quality data about AdvantageCare ACO’s performance as a MSSP ACO participant. For example, CMS measures AdvantageCare ACO’s performance on measures of patient satisfaction and patient safety. Once available, AdvantageCare ACO will provide that information here. Please check back later.

ACO Governing Body:

Read our Code of Conduct (PDF)

Shared Savings and Losses

Amount of shared savings/losses

Amount of Shared Savings/Losses will be shared once information is available to the ACO.

Shared Savings Distribution:

Shared Savings Distribution will be shared once this information is available to the ACO.

Quality Performance Results

Quality Performance results will be shard once this information is available to the ACO.

Payment Rule Waivers

• Skilled Nursing Facility (SNF) 3-Day Rule Waiver:
  • Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR § 425.612.
• Waiver for Payment for Telehealth Services:
  • Our ACO clinicians provide telehealth services using the flexibilities under 42 CFR § 425.612(f) and 42 CFR § 425.613.