Several health IT stakeholders say technology will play a key role in CMS' new "Next Generation Accountable Care Organization Model," which will expand coverage of telehealth services, FierceHealthIT reports (Bowman, FierceHealthIT, 3/11).

Details of New ACO Model

According to Modern Healthcare, the new model uses a combination of fee-for-service and capitation (Evans, Modern Healthcare, 3/10). It creates four payment systems and two risk tracks for its participants, including one with almost full risk (Williams, Healthcare Dive, 3/10).

In a blog post, Patrick Conway, CMO and deputy administrator for innovation and quality at CMS, wrote that the Next Generation ACO Model "sets more predictable financial targets." He explained, "To support increased risk, ACOs will have a stable, predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure to provide high quality care to patients" (Conway, CMS blog post, 3/10).  

In addition, he wrote that the new model "encourages greater coordination and closer care relationships between ACO providers/suppliers and beneficiaries" (FierceHealthIT, 3/11).

For example, the new model will make available several tools to bolster care management for beneficiaries. Such tools include expanded coverage of:

• Telehealth; and
• Post-discharge home services to facilitate at-home coordinated care (Walsh, Clinical Innovation & Technology, 3/10).

According to Politico's "Morning eHealth," CMS plans to allow Next Generation ACOs to receive payments for telehealth services, regardless of where the patient is located (Gold et al., "Morning eHealth," Politico, 3/12).

CMS said that it expects about 15 to 20 ACOs to participate in the new program, and it will publicly report participants' performance on quality metrics, including patient experience ratings, on its website (CMS webpage, 3/10).

Reaction

Several health IT groups have said they are encouraged by CMS' plan to expand telehealth coverage.

Jonathan Linkous, CEO of the American Telemedicine Association, in a statement said, "This is an important change in CMS policy and attitude. We hope it will encourage CMS and Congress to further open up all value-based payment plans to telehealth."

ATA called on CMS to take similar action among Medicare Shared Savings ACOs.

In addition, Joe Peterson -- president of Specialists on Call and chair of the Alliance for Connected Care -- in a release said, "This policy is a critical step forward in expanding the use of telehealth services in Medicare, which will allow for greater care coordination and improved quality of care." He added, "It represents a major victory for patients and the broader telehealth community, which has been gathering evidence of telehealth's benefits for decades" ("Morning eHealth," Politico, 3/12).

Meanwhile, Russell Branzell, president and CEO of the College of Healthcare Information Management Executives, said that health IT should be ready to support this next "logical step" in payment and management systems.

He said, "The concept of technology readiness for telehealth and telemedicine is not the issue here, but rather encouragement to move to a payment reform model and a patient care flow model that can utilize that technology" (FierceHealthIT, 3/11).