This methodology allows the ACO to know upfront which patients they will be held accountable for, and it empowers the ACO to track expenditures and measure care progress for specific patients throughout the year. Prospective attribution uses historical claims data to determine patient attribution. This ensures that only patients who met the inclusion criteria in the preceding year are counted toward the ACO’s attributed lives. Retrospective attribution, or “performance year attribution,” assigns a patient to an ACO based on the physician(s) or clinician(s) from whom the patient received his or her care during the performance year. Success in any aligned delivery system, including an ACO, requires you to monitor and manage quality and cost.Īre there different types of attribution? MACRA repealed the sustainable growth rate (SGR) and established a payment system that transitions away from fee-for-service (FFS) payment.The tracks within MACRA aligned with ACOs are Advanced Alternative Payment Model (AAPM) and Merit-based Incentive Payment System Alternative Payment Model (MIPS APMs). On April 16, 2015, Congress signed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) into law.
This gave both federal and commercial insurers impetus to improve quality and lower cost by altering the incentives in their payment methods. The Patient Protection and Affordable Care Act (ACA) laid the groundwork for innovative approaches to health care delivery.
What is an accountable care organization, or ACO?Īn ACO is a group of health care physicians and clinicians who agree to share responsibility for the quality, cost, and coordination of care with aligned incentives for a defined population of patients.
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