For the last 10+ years, most providers participating in Medicare Accountable Care Organizations (ACOs) have done so under the umbrella of an ACO aggregator. These aggregator organizations form risk-bearing entities, contract with CMS, and then recruit physician groups to participate in their ACO. While this “I’ll drive, you can ride in the back seat” type arrangement had some merit during the early years of the Medicare ACO journey, it has become obsolete and detrimental to providers, particularly as the drive toward more advanced value based payment arrangements across all lines of business continues to gain momentum.

1. Why isolate your Medicare ACO from the rest of your value based payment arrangements for Medicare Advantage, commercial, Medicaid, direct to employer and, when applicable, your own self insured employee population? High performing physicians and medical practices, particularly primary care, operate from an empaneled patient approach, including all of the patients attributed or assigned to them through any value based payment arrangement. It is important for those physicians, practices and the wrap around care team to have a singular set of data, tools and workflows to manage total cost of care; quality and clinical documentation gap closure; and clinical continuity (reduce leakage). When there is an ACO aggregator involved there are often barriers to one consistent care plan, dataset, financial incentive alignment and network management approach to the entirety of a medical group, clinically integrated network or health system’s value based payment arrangements and attributed or assigned members – this can adversely affect performance and improve administrative costs.
2. Why forfeit your upside? Most ACO aggregators require participating providers to give up half of the shared savings they earn. The rationale for this forfeiture is that the aggregator provides population health expertise, administrative support and some level of downside risk protection. The reality however is that the aggregators do not invite providers to participate in their ACO unless they believe that the provider group is already likely to generate savings. As for administrative support and population health expertise, this value-add diminishes with each passing year that the provider group gains experience in the ACO.
3. Why risk being abandoned? The era of SPACs, spendthrift VCs and bold M&A activity ended abruptly in 2023. Since then, many of the upstart aggregators who rapidly expanded via generous but unsustainable provider incentives have been left reeling and financially vulnerable. Some have closed shop and/or abandoned their participating providers. Other more established players face an uncertain future; rattled by multiple acquisitions, potential future divestiture, and shaky earnings reports. Provider groups on their Medicare Value Based Care (VBC) journey cannot afford to sit out a year because they have been unceremoniously dropped by their aggregator, nor can they risk impetuous last-minute decisions made by CEOs and CFOs with little understanding of value-based-care.
4. Avoid canned, one-size-fits-all approaches: Most aggregators have a standard population health approach that they deploy across all their participants and ACOs. They give little deference to the providers themselves and the fact that these providers know their beneficiaries best. Providers don’t need to be badgered with heavy-handed population health interventions. Rather, they should be armed with the information they need to succeed and supported in developing custom interventions for their beneficiaries.
5. Own your data: CMS provides Medicare ACOs with a wealth of data about the assigned population. ACO aggregators often don’t share that data with their participant providers. This is your data about your beneficiaries. It should not be held hostage by an umbrella organization as a barrier to your provider group seeking new partners and/or starting their own ACO.
6. Take advantage of new CMS offerings: In its effort to try and get all Medicare Beneficiaries in an accountable care relationship by 2030, CMS has introduced new incentives and programs (e.g. ACO Primary Care Flex) designed to help providers be successful in value-based care. These incentives and programs make it more feasible and appealing than ever before for providers to step into the driver seat of their own Medicare ACO.

COPE Health Solutions (CHS) offers a Medicare ACO partnership model that empowers providers to take control of their Medicare MSSP ACO and overall value based care journey. We offer clinical insights, financial insights, a self-service VBC analytics platform, subject matter experts across all population health capabilities and lines of business, and a mix of boots on the ground and remote program management support. Our partnership model is flexible and seeks to make provider groups more self-reliant over time; scaling back our presence over time is a sign of a job well done.

We believe that now is an opportune time for ACO Participants to become ACO Leaders. For a free consultation and to learn more about CHS’ capabilities in the Medicare ACO space, we encourage you to email us at info@copehealthsolutions.com.