Frequently Asked Questions For Providers
What are the benefits of joining Orange's Medicare ACOs?
Orange prides itself on being patient-centered and physician-led, which means that patient care and physician independence have and will continue to be the main drivers of Orange’s success. By joining Orange, you maintain your independence and autonomy as a physician, while entering into a dynamic network of providers focused on quality of care who receive one of the highest shared savings bonuses in the industry on normal Medicare Fee-for-Service rates. Orange providers also benefit from the expertise and guidance of a leadership team with more than 250 years of combined healthcare experience in the fields of population health management, primary-care services, informatics, pharmaceuticals, clinical programs, billing and coding, payer contract negotiations, human resources, and revenue optimization.
Orange offers additional support for your office staff, including IT, EMR, and front office support, an extensive preferred provider network that will help increase your share of savings, and care management teams that increase patient satisfaction through telehealth, coordination, and preventive care services.
How many ACOs can I join?
You can only participate in one Medicare ACO as a Primary-Care Physician. Specialists can join multiple ACOs.
What is the fee to join an ACO?
There is absolutely no cost to join Orange ACOs.
Will the ACO bill for my Medicare patients?
No, however, the ACO will educate practices on revenue enhancement opportunities (including billing) while meeting quality measures.
What is the difference between the various Medicare ACO models?
- Pioneer – According to CMS: “The Pioneer ACO Model is a shared savings payment policy with generally higher levels of shared savings and risk for Pioneer ACOs than levels currently proposed in the Medicare Shared Savings Program. In year three of the program, participating ACOs that have shown a specified level of savings over the first two years will be eligible to move a substantial portion of their payments to a population-based model.”
- Medicare Shared Savings Program (“MSSP”) – According to CMS: “The Medicare Shared Savings Program (Shared Savings Program) was established by section 3022 of the Affordable Care Act. The Shared Savings Program is a key component of the Medicare delivery system reform initiatives included in the Affordable Care Act and is a new approach to the delivery of health care. Congress created the 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. Eligible providers, hospitals, and suppliers may participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO).”
- Next Generation – According to CMS: “The Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients. It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP). The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care coordination, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.
- Medicare/Medicaid – According to CMS: “The Medicare-Medicaid ACO (MMACO) Model is focused on improving quality of care and reducing costs for Medicare-Medicaid enrollees. The MMACO Model builds on the Medicare Shared Savings Program (Shared Savings Program), in which groups of providers take on accountability for the Medicare costs and quality of care for Medicare patients. Through the Model, CMS will partner with interested states to offer new and existing Shared Savings Program ACOs the opportunity to take on accountability for the Medicaid costs for their assigned Medicare-Medicaid enrollees.”
What is the difference between the various MSSP ACO tracks?
As explained by CMS: “Medicare ACOs can choose to accept either one-sided or two-sided financial risk.”
- Track 1: Under the one-sided model, an ACO may receive shared savings if it meets the applicable requirements, but it will not be liable for shared losses.
- Track 1+: The new Model is based on the Shared Savings Program Track 1, but incorporates elements of Track 3 including: prospective beneficiary assignment to allow ACOs to know in advance the patient population for which they are responsible; the introduction of downside risk (although lower than Track 3); and the option to request a Skilled Nursing Facility (SNF) 3-Day Rule Waiver to provide greater flexibility to Track 1+ ACOs to better coordinate and deliver high quality care.
- Track 2: Under the two-sided models (Track 2 and Track 3), the ACO may share both savings and losses. This policy provides an opportunity for more experienced ACOs to enter a sharing arrangement that provides a greater share of savings, but with the responsibility of repaying Medicare a portion of any losses. In MSSP, Track 2 ACOs can earn up to 60% of any savings, while
- Track 3: Similar to Track 2, the ACO may share both savings and losses. Track 3 ACOs see maximum shared savings rates of 75%.
How are ACOs Reimbursed?
As explained by CMS: “Under the program regulations, Medicare continues to pay individual ACO providers and suppliers for covered items and services as it currently does under the Medicare Fee-For-Service payment systems. CMS also develops a benchmark for each ACO against which ACO performance is measured to assess whether the ACO generated savings or losses for the Medicare program during a performance year. ACOs that meet or exceed a minimum savings rate (MSR), satisfy minimum quality performance standards, and otherwise maintain their eligibility to participate in the Shared Savings Program are eligible to receive a portion of the savings they generate (“shared savings”). In addition, if an ACO has chosen to operate under a two-sided risk model, and it meets or exceeds a minimum loss rate (MLR), it must repay a portion of the losses it generates (“shared losses”).”
When can I join Orange Care Group?
Although specific program enrollment deadlines vary, Orange Care Group accepts applicants year-round for our Medicare ACOs, Independent Physician Associations, as well as Management Services Organization. Use the Contact Us page to start the process.
Will Orange submit my PQRS to CMS?
Will Orange help me with Meaningful Use?
Will Orange help me choose an EMR?
Does joining an ACO help with new MACRA laws?
Yes. As a participant in Orange ACOs, you are supported by a team of MACRA experts who will help you successfully meet all requirements. You will be joining a team that has consistently achieved high quality scores.
Will ACOs continue if the Affordable Care Act is repealed?
MACRA, which heavily pushes forward ACO models, recently passed both houses handily. Medicare Alternative Payment Models have been bipartisan.
Clif Gaus, President and CEO of the National Association of ACOs (NAACOS) recently stated:
“Observers at NAACOS are hearing from congressional contacts that ACOs are not part of any repeal. Their value holds up as a market-based alternative to fee-for-service at one extreme and capitation at the other, and with 200,000 physicians participating, Tom Price will recognize that and support an advanced payment model for physicians with the goal of population health management.”
What about my Medicare advantage plan patients?
Medicare Advantage plan patients cannot participate in Medicare ACOs; however, Orange does provide a Management Services Organization that contracts with several Medicare Advantage Plans for which you may be eligible.