WASHINGTON, D.C.– Evolent Health, a company providing an integrated value-based care platform to the nation's leading health systems and physician organizations, today announced that ten of its partners have been formally accepted to the Center for Medicare and Medicaid Services’ Next Generation Accountable Care Organization (ACO) program for the 2018 performance year, including four provider partners that are new to Evolent’s network. Evolent will support nearly one-fifth of all organizations accepted to the Next Generation ACO program nationwide to manage cost and quality of care for Medicare beneficiaries.
New partners joining Evolent’s existing Next Generation ACO cohort include CoxHealth in Missouri, Franciscan Missionaries of Our Lady Health System Health Leaders Network (FMOLHS-HLN) in Louisiana, South Shore Health System in Massachusetts, and St. Joseph’s Health in New Jersey.
“Health and Human Services Secretary Alex Azar’s commitment to accelerating Medicare transformation demonstrates that the trend toward public-private healthcare and payment model innovation remains strong,” said Evolent Health Chief Executive Officer Frank Williams. “By participating in the Next Generation ACO program, our partners are aligned with the continued, accelerated shift to value-based reimbursement. We look forward to collaborating with our ACO partners in support of their Medicare beneficiaries and other populations as they scale their value-based care strategy.”
Across its Next Generation ACO cohort, Evolent is deploying physician-led, evidence-based patient programs and market-leading technology to improve quality, reduce cost and enhance the care experience for its partners’ Medicare beneficiaries. Evolent’s partnership model enables providers to take on upside and downside risk in programs like Next Generation ACO by providing core capabilities for maximizing savings and improving quality. These capabilities include care and quality performance management; coding and documentation education for physicians; analytics and reporting to drive collaboration across the provider network; and population health technology with Evolent’s Identifi℠ platform.
Participation in the Next Generation ACO program has nearly tripled since the program’s inception in 2016. This has been driven in part by the bipartisan MACRA legislation that incents providers to move into advanced payment model tracks. The Next Generation ACO program is currently the only advanced payment model in which the share/loss ratio can be as high as 100%. This enables provider organizations to capture more of the value they are creating by delivering higher quality and lower cost care.
In addition to Next Generation ACOs, many provider organizations are looking to Medicare Advantage as a program in which they can take on full financial and clinical risk and capture even more value. CMS expects Medicare Advantage enrollment to nearly double by 2025 to approximately 30 million members with the Baby Boomer generation aging into Medicare. CMS has also indicated that it is considering higher payment rates and increased quality incentives for providers serving MA plan members.
“We believe the leadership at HHS and CMS have made clear their intention to make Medicare Advantage an increasingly attractive option in the future, and many providers want to take advantage of this window of opportunity to build their skills in managing clinical and financial risk for all Medicare beneficiaries in their community,” said Evolent Health Senior Vice President of Medicare Partnerships Chris Dawe. “Beyond the technical capabilities that are needed in both the Next Generation ACO and Medicare Advantage programs, such as predictive modeling for identifying high-risk patients and effective network performance management, we see our cohort partners taking advantage of the experience of their peers in our ACO cohort, calling one another and sharing lessons learned to help accelerate success in different regions of the country. The overall platform is a powerful catalyst for change.”
Evolent has managed financial and clinical outcomes with partners participating in Medicare Shared Savings Programs Tracks 1 and 3, the Next Generation ACO program in 2016 and 2017 performance years, and those serving Medicare Advantage plan members.
About Evolent HealthEvolent Health partners with leading provider organizations to achieve superior clinical and financial results in value-based care. With a provider heritage and over 20 years of health plan administration experience, Evolent operates in more than 30 U.S. health care markets, actively managing care across Medicare, Medicaid, commercial and self-funded adult and pediatric populations. With the experience to drive change, Evolent confidently stands by a commitment to achieve results. For more information, visit evolenthealth.com.