20 Interesting Takeaways From the CMS NORC Next Generation ACO First Annual Report

By Clive Riddle, September 7, 2018

The recently released 111-page Next Generation Accountable Care Organization (NGACO) Model Evaluation First Annual Report prepared by NORC on behalf of CMS provides a treasure trove of ACO tidbits, as CMS uses the report to tout emphasizing higher risk sharing arrangements. Here’s the NGACOs examined in the report, followed by twenty selected interesting takeaways:

1. There were 18 active NGACOs in 2016, with 15 having prior Medicare ACO experience
2. These 18 NGACOs served 477,197 beneficiaries, with 31,070 network providers and 775 network facilities
3. In aggregate, NGACOs served three percent of total Medicare beneficiaries in all markets
4. On average, a 2016 NGACO served about 26,500 aligned beneficiaries (median of 24,219 beneficiaries)
5. NGACOs are associated with a 1.7% reduction in Medicare spending for aligned beneficiaries totaling $100.08 million (1.1% reduction after shared savings payment went to NGACOs)
6. The estimated gross reduction in Medicare spending with $18.20 per beneficiary per month ($11.20 reduction after $7.00 in shared savings went to NGACOs)
7. NGACOs experienced 1.7/1,000 fewer IP Hospital Days (1.3% reduction) and 20.4/1,000 more wellness visits per year (11.9% increase)
8. Standardized risk-adjusted, per capita Medicare spending in NGACO markets ($9,638) is comparable to that of non-NGACO markets ($9,519)
9. Considered geographically, many NGACOs have contiguous or overlapping markets and are concentrated in the Midwest (11 ACOs), with pockets in the Southeast (7 ACOs) and Northeast (4 ACOs)
10. Nine NGACOs are in highly concentrated markets, dominated by one or a few hospital systems 
11. NGACOs operate in markets with high Medicare Advantage and Shared Savings Program penetration rates
12. Commercial and Medicaid ACO initiatives are more likely to be located in NGACO markets
13. Eleven of the 18 2016 NGACOs were integrated delivery systems 
14. On average, physicians represented more than half of each NGACO’s governing board membership
15. Most 2016 NGACOs chose to assume 80 percent risk and the fee-for-service (FFS) payment mechanism
16. Twenty-four percent of the 2016 NGACO participating providers’ Medicare FFS revenue from paid QEM visits was generated from care provided to NGACO-aligned beneficiaries.
17. Seventy-one percent of aligned beneficiaries’ paid QEM visits were within their respective NGACO provider networks, compared with forty percent of the comparison group’s
18. All but two NGACOs had preferred providers in their networks
19. All NGACOs address end-of-life care
20. The SNF waiver was the most commonly implemented of the three NGACO model benefit enhancements