As a companion to federally structured reimbursement programs, such as the Medicare Shared Savings Program (MSSP), established in the Patient Protection and Affordable Care Act (ACA), a variety of risk-sharing, cost-reducing innovations have emerged within the private payer sector. Among them are Commercial Accountable Care Organizations, which are clinically integrated networks of health care providers that receive reimbursement from commercial payers or self-insured employers on a “shared savings” basis (Commercial ACOs).
How does this Like their MSSP counterparts, Commercial ACO network participants are typically reimbursed on a fee-for-service basis and can potentially receive a portion of “savings” achieved for a defined patient population over a period of time, usually in twelve-month increments. Savings are calculated by comparing current spending to baseline spending for the patient population. Additionally, to be eligible to share in the savings, certain quality and performance measures generally must be attained by the Commercial ACO. Commercial ACOs carry the promise of reducing commercial health care spending and improving quality of patient care while affording participants flexibility in arrangement, ownership and operational design.