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 an d practices that comprise Atrius Health (Dedham Medical Associates, Granite Medical Group, 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 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.
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 doctors 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.
What Is the New Coordinated Care Reward, and How Do Beneficiaries Receive It?
As a part of being associated with our Next Generation ACO, you can get a $25 check as a Coordinated Care Reward when you get your Annual Wellness Visit from your doctor who participates in our Next Generation ACO. An Annual Wellness Visit is a chance for you to discuss your health, your medications, and your team of doctors with your primary care physician to ensure s/he can coordinate your care. An Annual Wellness Visit isn’t a physical; it’s a distinct visit that can be received once a year, which lets you have a conversation with your doctor about your health. Such visits have been shown to improve health care for beneficiaries, which is why you will be rewarded by CMS for receiving an Annual Wellness Visit.
CMS, the agency that runs Medicare, will send the check to the address you have listed with the Social Security Administration (SSA). CMS will identify beneficiaries who qualify for the reward on a quarterly basis, so that you can get your $25 check as soon as possible within the next quarter following your Annual Wellness Visit. To get this check please make sure Social Security has your current mailing address by creating an account and updating your profile on their website, www.ssa.gov/myaccount.
About Atrius Health's Participation in the Next Generation ACO
For general information on Medicare ACOs, click here. You can find additional information on the Next Generation ACO Model. 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
Beth Honan, (Primary Contact)
Chief Contracting Officer - Atrius Health
Rick Lopez, MD (Medical Director)
Senior Vice President, Population Health - Atrius Health
Marci Sindell (Speaking Engagements)
Chief Strategy Officer & Senior Vice President, External Affairs – 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), 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.
2018 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 2018 and are participating in our Next Generation ACO.
ACO Shared Savings and Losses
Next Generation: Shared savings or losses will be calculated for our first performance year (2017) sometime in the summer of the following year. As with our Pioneer ACO, 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. You can find a list of the Atrius Health participating SNFs here.
Medicare Telehealth Expansion: Telehealth services allow beneficiaries to receive some health care services using real-time communication between the beneficiary and his/her primary care provider or specialist. All of Atrius Health’s Next Generation ACO Participants and Preferred Providers are approved to provide services under this benefit enhancement.