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Accountable Care Organization
Next Generation Accountable Care Organization (ACO)
What is a Next Generation ACO?
The Next Generation ACO is a Model where health care providers who share a common vision of improving your care can work together more effectively by belonging to an ACO. The providers and practices that comprise Atrius Health (Dedham Medical Associates, Granite Medical Group, PMG Physician Associates, and Harvard Vanguard Medical Associates) are voluntarily taking part in this Model as we believe it will help in providing better quality care for our Medicare fee-for-service (aka “Original” Medicare) patients. All of the health care providers participating in the Atrius Health Next Generation ACO have joined with the Centers for Medicare and Medicaid Services (CMS) in committing to your needs and preferences, and to emphasize the coordination of your care.
“Atrius Health has a long history of success in providing leading-edge care to our patients as an accountable care organization. We are proud to continue this journey as part of the Next Generation ACO Model. Our experience as a Pioneer ACO enabled us to build upon our strengths in providing high-quality, coordinated care for our patients across the continuum. CMS has been an excellent partner in this work, and we look forward to further collaboration and innovation with them in the years to come.”
—Steven Strongwater, MD, President & CEO of Atrius Health
What Does Our Next Generation ACO Mean for Beneficiaries?
As a Medicare beneficiary, you still have the right to use any doctor or hospital who accepts Medicare, at any time, even if your Atrius Health medical group provider is part of our Next Generation ACO. There is no change to your Medicare benefits; a Next Generation ACO is not a Medicare Advantage plan or an HMO plan. Your providers at the Atrius Health medical groups will continue to recommend doctors or hospitals for your specific health needs, but it is always your choice about which doctors you use or which hospitals you visit. For more information, contact 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov.
Annual Wellness Visits
In previous years, some patients whose providers worked with an ACO received a $25 “Coordinated Care Reward” check from Medicare for attending their Annual Wellness Visit. Medicare has decided not to continue this reward payment in 2019. However, Atrius Health still strongly encourages all eligible Medicare beneficiaries to visit us to receive this important service, which Medicare will continue to cover at no out-of-pocket cost. An Annual Wellness Visit is not the same as a physical. It is a special visit that beneficiaries are eligible for once a year to discuss health goals with their provider or the provider’s staff. Such visits have been shown to improve health care for beneficiaries.
About Atrius Health's Participation in the Next Generation ACO
For general information on Medicare ACOs, click here. You can also find additional information on the Next Generation ACO Model here. Beneficiaries can call 1-800-MEDICARE (1-800-633-4227), TTY users should call 1-877-486-2048 for any questions or concerns. You may also contact Atrius Health as noted below.
Name of ACO:
Atrius Health, Inc.
Riverside Center, 275 Grove Street, Newton, MA 02466
James Woolman (ACO Executive)
Vice President, Network Contracting & Financial Integration – Atrius Health
Peggy Chou, MD, MBA (ACO Medical Director)
Senior Medical Director, Performance Excellence – Atrius Health
Governing Body: The Atrius Health Board of Trustees serves as the Atrius Health Next Generation ACO Governing Body. Trustee Vinod Sahney serves as the Consumer Advocate and Medicare Beneficiary member of the Next Generation ACO Board. The Atrius Health Board of Trustees has committees that also serve the Atrius Health Next Generation ACO Board as appropriate. These committees include Governance (Chair - Rob Mechanic), Compensation (Chair - Rich MacDonald), Audit/Compliance (Chair - Leslie Teso-Lichtman), System of Care Performance (Chair - Vin Sahney), Finance (Chair - Theresa Bresten), and Strategy (Chair - Guy Spinelli). For a full list of trustees, click here.
2019 Next Generation ACO Participants and Preferred Providers: Click here for a list of the adult practice physicians, nurse practitioners, physician assistants, and clinical nurse specialists who are employed or contracted by Atrius Health in 2019 and are participating in our Next Generation ACO.
There are no joint ventures between or among the Next Generation ACO and any of its Participants and Preferred Providers.
ACO Shared Savings and Losses
Atrius Health ACO produced $19.9 million in gross savings to Medicare for our first year of participation (2017) in the Next Generation ACO Model, $15.0 million of which was received back as shared savings to our organization. As with our Pioneer ACO (2012-2016), Atrius Health anticipates reinvesting 100% of shared savings into our programs.
Medicare 3-day Skilled Nursing Facility (SNF) Rule Waiver: Under current Medicare law, Medicare only covers care in a SNF if a patient has a prior 3-day inpatient hospital stay. The Rule Waiver available under the Next Generation ACO Model may allow beneficiaries to get Medicare-covered SNF services at a participating SNF without a mandatory 3-day inpatient hospital stay. View a list of the Atrius Health participating SNFs.
Other Waivers: Atrius Health is also developing additional programs under new and continuing Next Generation ACO Benefit Enhancement Waivers. Once active, these waivers would support expanded access to Telehealth services, in-home Care Management visits to avoid unnecessary hospitalization, and a rewards program for participation in Chronic Disease Management activities.
Medically Home Program Waiver
Atrius Health, Inc. participates in the Next Generation Accountable Care Organization (NGACO) Model under a contract with the Centers for Medicare & Medicaid Services (“CMS") Center for Medicare and Medicaid Innovation (“CMMI”). The Department of Health and Human Services provides certain waivers of federal fraud and abuse laws pursuant to a Notice of Waiver of Certain Fraud and Abuse Laws in Connection with the Next Generation ACO Model dated December 9, 2015, as amended December 29, 2016 and December 12, 2018, including the Next Generation ACO Participation Waiver (“Participation Waiver”) and the Next Generation ACO Waiver for Patent Engagement Incentives. On May 8, 2019, the Atrius Health Board of Trustees, which also serves as the NGACO governing body, made a bona fide determination that the Arrangement described here is reasonably related to the purposes of the Atrius Health NGACO and voted to approve the Arrangement.