Central Maine ACO
Program Location:
Lewiston, ME
Payer Type:
Medicare
Partner Organizations:
Central Maine Healthcare
Parent Program:
Payers:
Medicare
Reported Outcomes
Description:
ACO’s, while still evolving, are expected to connect groups of providers who are willing and able to take responsibility for improving the health status,efficiency and experience of care the “Three Part Aim” for defined populations.
An effective Shared Savings Program will include:
- Patient-centered primary care medical homes that coordinate with other providers.
- Aligned networks of specialists, ancillary providers and hospitals focused on outcomes.
- Explicit care integration, transition of setting coordination and quality tracking and reporting.
- Payor provider partnership relationships and financial reimbursement models identified under healthcare reform that facilitate and reward high value, not high volume, healthcare.
- Population health information infrastructure to enable community-wide care coordination.
The Central Maine ACO incorporates PCMH in primary care provider offices through enhanced access and a team-based approach to care. Care managers use focused interventions, population management, internal partnerships, risk stratification, and community partnerships to promote sustainability.
Payment Model:
For an ACO’s first performance year, the repayment mechanism must be equal to at least 1 percent of its total per capita Medicare Parts A and B fee-for-service expenditures for its assigned beneficiaries, as determined based on expenditures used to establish the ACO’s benchmark (§425.204(f)). CMS estimates the amount of the ACO’s initial repayment mechanism based on available historical data, and will give this estimate to the ACO around the time CMS accepts its application.
To continue to participate in the program, each Track 2 ACO must annually demonstrate the adequacy of its repayment mechanism before the start of each performance year in which they take risk (§425.204(f)(3)). The repayment mechanism for each performance year must be equal to at least 1 percent of the ACO’s total per capita Medicare Parts A and B fee-for-service expenditures for its assigned beneficiaries, as determined based on expenditures for the ACO’s most recent performance year. Before the start of the next performance year, CMS will give Track 2 ACOs an estimate of the amount of the repayment obligation for which they must establish a repayment mechanism for the upcoming performance year.
Improved Health:
- CAHPS score for health status/health functioning at 76.60 compared to the ACO mean of 73.05
Cost Savings:
- $2,597,466 in accrued savings in performance year one, but did not qualify for federal shared savings payment
Increased Preventive Services:
-
Preventive Care and Screening: Influenza Immunization at 94.66 compared to ACO mean of 72.52
-
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up at 93.55 compared to ACO mean of 70.69
-
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention at 99.19 compared to ACO mean of 90.48
Last updated March 2019
