Providence, RI: The Centers for Medicare & Medicaid Services (CMS) announced today that Integra Community Care Network, LLC, (Integra) will participate in the Next Generation Accountable Care Organization (ACO) Model effective January 1, 2017.
Integra Community Care Network has been participating in CMS’s payment and delivery reform as a certified Medicare Shared Savings Program with approximately 19,000 Medicare beneficiaries. Its participating provider network includes the Rhode Island Primary Care Physician Corporation (RIPCPC), Care New England Health System (CNE), South County Health System, and their employed and affiliated physicians.
The CMS website describes the Next Generation ACO Model 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. Next Generation ACOs that meet quality standards and reduce total health care spending will share in the savings achieved for the Medicare program. “We are excited about the opportunity presented by this initiative,” said Integra Chief Clinical Officer James E. Fanale, MD. “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.” In August 2016, CMS reported that Integra had realized savings of nearly $4 million on total health care spending of slightly more than $152 million. At the same time, Integra saw significant improvement on most quality measures, scoring at or above the national mean in most areas, and scoring higher than the national average in 22 out of the 34 measures. (MSSP 2015 Financial Reconciliation Reports, Quality Performance Results, available online
“This is a tremendous endorsement of what we have accomplished in our first year of operation,” said Albert Puerini, MD, president and CEO of RIPCPC and chairman of the Board of Integra. “Thanks to Integra’s community outreach and better collaboration with hospitals, PCPs and specialists, patients are going to the hospital less, visiting emergency departments less frequently, living in the community, and generally living healthier and more rewarding lives.”
In addition to ensuring more efficient, coordinated care, the Next Generation ACO Model includes robust patient protections around access and quality of care. “The ultimate test for this initiative is whether we hit the triple aim of health care reform: better care, better health, smarter spending,” said CNE President and CEO Dennis Keefe. “We are confident, based on our experience to date, that we can help patients live healthier and better lives, and spend resources more efficiently.” The CMS website also 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.”
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.
About Integra Community Care Network, LLC
Integra Community Care Network is a CMS certified ACO with more than 120,000 covered lives. Its participating provider network includes Rhode Island Primary Care Physician Corporation (RIPCPC), Care New England and South County Hospital and employed and affiliated physicians. Integra was also named as an Accountable Entity by the RI Executive Office of HHS and assumed responsibility for more than 30,000 Rite Care participants, effective January 1, 2016.