KentuckyOne Health Partners Accountable Care Organization is terminating its participation in the Next Generation Accountable Care Organization (NGACO) Model for Calendar Year 2018, effective March 28, 2018.
For Beneficiaries (Patients):
There is no action needed on your part. There is no change to the relationship you have with your health care providers. You will continue to receive the same excellent care from your doctors, and you still have access to our outstanding network of health care providers. Please note that this change does not impact you having Original Medicare and receiving all of the benefits associated with Original Medicare. However, KentuckyOne Health Partners and your health care practice will not participate in this Model during calendar year 2018. Because of this change, some benefits you may have utilized in 2017 will no longer be available in 2018. If you utilize these services in 2018, you may be responsible for payment.
The following benefits offered in 2017 will not be available for utilization in 2018:
Coordinated Care Reward for Annual Wellness Exam: As a part of being associated with a Next Generation Accountable Care Organization, a $25 Coordinated Care Reward is sent to beneficiaries when they get an Annual Wellness Visit from a provider participating in our ACO. An Annual Wellness Visit is a chance to discuss your health, your medications, and your team of doctors with your primary doctor to ensure s/he can coordinate your care. An Annual Wellness Visit isn’t a physical; it is a distinct visit that can be received once a year, which lets you have a conversation with your doctor about your health.
Benefit Enhancements and payment waivers do not survive termination of an ACO’s participation in the Next Generation ACO Model. If these services are utilized in 2018, claims will no longer be covered by Medicare and the Beneficiary may be responsible for payment of such services.
• 3-day Skilled Nursing Facility (SNF) Rule Waiver: Under current Medicare law, Medicare only covers care in a SNF if a patient has a prior 3-day inpatient hospital stay. This Next Generation ACO Benefit Enhancement allows Medicare coverage of SNF services at a participating SNF without a mandatory 3-day inpatient hospital stay.
• Post-Discharge Home Visits: To provide more comprehensive follow-up care at home after you are discharged from a hospital, Next Generation ACOs can help with the challenging transition between the hospital and home.
• Telehealth Expansion: Telehealth services allow you to receive some health care services using real-time communication between you and your primary care doctor or specialist.
For Participants (Health Care Providers):
Leaving the Next Generation ACO Model eliminates KentuckyOne Health Partner’s status as an Advanced Alternative Payment Model (A-APM). As a result, providers will report quality performance through the Merit-based Incentive Payment System (MIPS) for a performance-based adjustment to their Medicare payment. Beneficiaries will no longer be eligible for use of any NGACO waivers, including the 3-day Skilled Nursing Facility Rule Waiver, Post-Discharge Home Visits, or Telehealth Expansion (as noted above).
For Preferred Providers (Hospitals, Affiliate Providers, Skilled Nursing Facilities):
Beneficiaries will no longer be eligible for use of any NGACO waivers, including the 3-day Skilled Nursing Facility Rule Waiver, Post-Discharge Home Visits, or Telehealth Expansion (as noted above).
Catholic Health Initiatives, KentuckyOne Health, and KentuckyOne Health Partners have a proven track record of success improving the quality of care for the Medicare population previously for four years in a row through the Medicare Shared Savings Program, and will continue to lead the way in the acceleration of health care value.
If you have questions, please feel free to contact KentuckyOne Health Partners where we have staff available that can answer your questions at 1-877-543-5768. As always, you can contact Medicare directly at 1-800-MEDICARE (1-800-633-4227; TTY users can call 1-877-486-2048).