Medicare changes being implemented through the Patient Protection and Affordable Care Act will include new programs designed to improve the quality of care. In 2012, two such programs involve accountable care organizations and patient independence. What will these programs offer beneficiaries? Below are the details of each program.

Shared savings program for ACOs

In 2012, the Department of Health and Human Services (HHS) will establish a shared savings program to promote accountability for patient populations and to coordinate items and services. Under this program, groups of providers of services and suppliers meeting HHS criteria may work together to manage and coordinate care for Medicare fee-for-service beneficiaries through an accountable care organization (ACO). ACOs are groups of health care providers that cooperate in improving quality of care and costs for a particular patient population. ACOs that meet HHS quality performance standards will be eligible to receive payments for shared savings.

Groups eligible to participate as ACOs under the program include:

--ACO professionals in group practice arrangements;
--Networks of individual practices of ACO professionals;
--Partnerships or joint venture arrangements between hospitals and ACO professionals;
--Hospitals employing ACO professionals;
--Other groups as HHS determines appropriate.

The ACOs must contract with HHS for at least three years, and meet other requirements, including:

--A formal legal structure that would allow the organization to receive and distribute payments for shared savings to participating providers of services and suppliers;
--Processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as using telehealth, remote patient monitoring, and other enabling technologies;
--Meeting patient-centeredness criteria specified by HHS including the use of patient and caregiver assessments or the use of individualized care plans.

For protection of patients, HHS has also included a provision if an ACO has taken steps to avoid at-risk patients, in order to reduce the likelihood of increasing costs to the ACO. HHS may impose an appropriate sanction on the ACO, including termination from the program.

The Medicare Independence-at-Home Demonstration Program

This demonstration program includes medical practices with experience in providing home-based primary care to applicable beneficiaries (an individual or groups of physicians and/or nurse practitioners, and including nurses, physician assistants, pharmacists, and other health and social services staff). The program will allow the beneficiaries to access primary care through in-home visits. The practices will also be required to use electronic health information systems, remote monitoring, and mobile diagnostic technology.

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