Shared Service, Advanced Payment Model Accountable Care Organization

PDA helps client, Coastal Carolina Quality Care, Inc. (CCQC), to achieve CMS designation as a Shared Service, Advanced Payment Model Accountable Care Organization.

PDA assisted in preparation of the applications for both designations for the New Bern, North Carolina primary care-focused, multi-specialty physician group. CCQC was one of 27 named to the Shared Service designation on April 10, 2011, and only five selected for the Advanced Payment Model.

“We at CCQC are very excited about this opportunity. We expect to be able to improve the quality of care for our patients, while at the same time working in a partnership with CMS to reduce growth in overall expenditures.” said Kenneth W. Wilkins, Jr., MD, CCQC’s Chairman and President.

Shared Savings ACO

Section 3022 of the Affordable Care Act requires the Centers for Medicare & Medicaid Services (CMS) to establish a shared savings program to facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs. The Shared Savings Program is designed to improve beneficiary outcomes and increase value of care by:

  • Promoting accountability for care of beneficiaries
  • Requiring coordinated care for all services provided
  • Encouraging investment in infrastructure and redesigned care processes

Eligible providers, hospitals, and suppliers may participate in the Shared Savings Program by creating or participating in an Accountable Care Organization, also called an ACO.

As a complement to CMS’ Medicare Shared Savings Program, the Innovation Center is sponsoring the Advance Payment ACO Model to test whether and how pre-paying a portion of future shared savings could increase participation in the Medicare Shared Savings Program. Increasing participation in the Medicare Shared Savings Program may also increase the amount of and speed at which ACOs can improve care for beneficiaries and generate Medicare savings. The Advanced Payment Model ACO is open to two types of organizations:

  • ACOs that do not include any inpatient facilities AND have less than $50 million in total annual revenue.
  • ACOs in which the only inpatient facilities are critical access hospitals and/or Medicare low-volume rural hospitals AND have less than $80 million in total annual revenue.

CCQC will now show compliance with 33 quality indicators for patient care and have an opportunity to share in savings associated with patient care improvement.

Note:  Notices of Intent for January 2015 program participation are due by May 30, 2014. See the full application schedule here.

How may we help you?

To discuss how we may help your organization call us at: (919) 754-0303

or email pdaconsultant@pda-inc.net.