Medicare’s largest and most successful value-based care program celebrates its 10th anniversary in 2022. The Medicare Shared Savings Program (MSSP) started in April 2012, and welcomed the first 27 accountable care organizations (ACOs) to participate in the program. This first class of MSSP ACOs covered nearly 375,000 beneficiaries across 18 states. A decade on, the MSSP now includes 483 ACOs serving 11 million beneficiaries across all 50 states, Washington, DC, Puerto Rico and the U.S. Virgin Islands.
UC San Diego Health Accountable Care Network is a Track 1+ Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) that includes UC San Diego Health faculty and facilities, community hospitals, community primary care providers, and specialists. We are proud to serve more than 30,000 beneficiaries in San Diego, Riverside, and Imperial Counties.
Our mission is threefold: to enhance the patient experience, make quality care more efficient and accessible, and improve health for various patient populations. The ACO leverages our experienced integrated care teams to deliver high-quality, value-based care with support from regional hospitals and community physician practices.
In 2014, UC San Diego Health began integrating with community physicians and local hospitals, collaborating on administrative functions, business, and clinical initiatives to improve efficiencies and benefit patients. Today, UC San Diego Health is aligned with Tri-City Medical Center in Oceanside, El Centro Regional Medical Center in El Centro, and more than 500 select community physicians and specialists from San Diego, Imperial, and Riverside Counties.
These partnerships support acute in-patient care and a spectrum of outpatient primary and specialty medical and surgical services, including ambulatory and emergency patient care.
Similar to our Affiliated Network, we’ve established extensive qualifying parameters for our Accountable Care Network.
Accountable Care Network participants must meet the following standards:
Actively participate in the ACO’s governance committees and partner with our staff
Continually monitor best practice care protocols and patient experience
Use a federally certified EMR system and actively share population health information from their EMR to support patient care
Meet and comply with our data-sharing requirements and quality reporting initiatives
Our clinical care network includes more than 150 primary care physicians, over 1,000 physicians in 40 specialties, and hundreds of non-MD providers. In addition to the UC San Diego Health faculty, the Affiliated Network also includes more than 500 providers and over 40 affiliated community practices.
UC San Diego Health Accountable Care Network participant practices include providers in the following specialty areas:
According to the Centers for Medicare and Medicaid Services (CMS), an ACO is composed of groups of doctors, hospitals, and other healthcare providers who come together voluntarily to give coordinated, high-quality care to their Medicare fee-for-service beneficiaries.
UC San Diego Health formed an MSSP ACO to proactively respond to federal initiatives by CMS aimed at coordinating patient care to reduce system waste and achieve better patient outcomes. By forming an MSSP ACO, UC San Diego Health and participating providers are embracing innovative CMS payment models that reward quality care.
The Medicare Access CHIP Reauthorization Act (MACRA) changes the way Medicare pays providers. MACRA repeals the Sustainable Growth Rate formula, streamlining multiple quality reporting programs into the newly formed Quality Payment Program (QPP), and rewarding value over volume.
Eligible clinicians can participate in one of two payment paths:
Merit Based Incentive Payment System (MIPS); or
Advanced Alternative Payment Models (A-APMs).
Most Medicare Part B clinicians will be subject to MIPS. Under MIPS, providers receive adjustments to their Medicare fee-for-service reimbursement based on a composite performance score measuring i) quality, ii) resource use (cost), iii) clinical practice improvement activities, and iv) advancing care information.
CMS incentivizes providers to participate in Advanced APMs, the alternative to payment under MIPS. Providers who participate in Advanced APMs can avoid MIPS and receive an annual 5 percent bonus on top of their Medicare Part B reimbursement. CMS applies thresholds to Advanced APMs to determine if the model is a qualifying participant. If the Advanced APM meets the thresholds, then the participants are excluded from MIPS and eligible for the annual 5 percent bonus.
Advanced APMs under MACRA include the following: MSSP ACO Tracks 1+, 2, and 3; the Next Generation ACO Model; the Comprehensive ESRD Care Model; the Oncology Care Model; and the Comprehensive Primary Care Plus Model.
UC San Diego Health Accountable Care Network is an MSSP Track 1+ ACO Model. This is a newly formed MSSP ACO model under MACRA that incorporates lower downside risk than in MSSP ACO Tracks 2 or 3.
Participation in a qualifying ACO allows providers to forgo MIPS and receive an annual 5 percent bonus over Medicare Part B reimbursement.
Participants have the opportunity to receive shared savings from the ACO as the network demonstrates its ability to lower health care costs while meeting CMS quality standards.
UC San Diego Health shelters participants from downside risk for the first 3-year agreement period.
Because the ACO is a Track 1+ model, participants in the Accountable Care Network benefit from prospective—rather than retrospective—beneficiary assignment for required reporting and financial reconciliation. In other words, ACO participants know which Medicare patients are assigned to the patient population being cared for in the ACO.
Alignment with UC San Diego Health Accountable Care Network provides practices with several benefits, including full access to the Epic electronic health record and information systems, collaboration with UC San Diego Health specialty providers, a shared network for care coordination and support through the evolution of healthcare regulations.
Each taxpayer identification number or CMS Certification Number (CCN) billing Medicare for primary care services (as defined in the MSSP regulations at §425.20) must be exclusive to one ACO’s certified list of ACO participants. Exclusivity in UC San Diego Accountable Care Network applies to Medicare FFS only and doesn’t preclude you or your practice from participating in other IPA or payer network arrangements.
According to CMS, the following provider types must be exclusive to a single ACO:
Multispecialty clinic or group practice
Osteopathic manipulative medicine
Physical medicine and rehabilitation
Primary care (e.g., internal medicine, general practice, family practice, geriatric medicine, or pediatric medicine)
No, although we do encourage all ACO participants to explore the many benefits and opportunities of collaborating with UC San Diego Health through the Physician Network, including an array of commercial health plan arrangements. Conversely, not all Physician Network affiliates are required to participate in UC San Diego Health Accountable Care Network. For more information, please use the contact form.
Medicare requires a list of ACO participant TINs in order to attribute a given provider, practice, or hospital to an ACO. Therefore, CMS requires all providers who bill Medicare under a single TIN to agree to participate in the ACO.
If you currently participate in another Medicare Shared Savings Program ACO and would like assistance transitioning to the UC San Diego Health ACO, our staff can guide you through the required steps. Note that your practice is responsible for completing the close-out process when terminating your existing MSSP ACO participation agreement, including furnishing data necessary for the annual assessment of the ACO’s quality of care.
The UC San Diego Health ACO will reserve 40% of shared savings for reinvestment in the ACO and distribute the remaining 60% to ACO participant providers. Shared savings reserved for ACO reinvestment will be used to fund administrative and operational expenses, such as the implementation of a single EMR across the ACO and additional resources for the centralized care management team.
Beneficiaries (patients on Medicare) are assigned to UC San Diego Accountable Care Network if they receive the plurality of their primary care services from PCPs (physicians or non-physician practitioners) with our ACO.
Providers continue to submit claims to Medicare under their existing Tax ID and NPI numbers, and Medicare reimburses on a fee-for-service basis, as they have in the past. For ACO participants, CMS provides routine reporting for assigned beneficiaries including information on utilization, cost, and quality to UC San Diego Health to determine performance against the established benchmark. UC San Diego Health will disseminate the data throughout the performance year and offer feedback on various measures to assist in enhancing performance and achieving savings.
Fee-for-service Medicare beneficiaries treated by providers who are participating in a Medicare Shared Savings Program ACO maintain all of their Medicare rights, including the right to choose any doctors and providers that accept Medicare. Whether a provider chooses to participate in an ACO, their existing Fee-for-Service Medicare patients may continue to see them.
Learn more about ACOs
For general questions or additional information about Accountable Care Organizations, visit medicare.gov/acos.html or call 1-800 MEDICARE (800-633-4227). TTY users should call 1.877.486.2048.