The current novel coronavirus (COVID-19) pandemic poses a unique challenge to health systems and provider groups participating in accountable care organizations (ACOs) and other alternative payment models. Like all health care institutions, they will face higher patient volumes, higher patient acuity, and shortages of staff, supplies, and space. However, by participating in models that hold them responsible for total costs of care, they also stand to lose financially as costs of care increase. They also potentially will face limitations on metric collection and reporting and when time and resources are at a premium.
If nothing is done, participation in alternative payment models may dramatically decline as institutions drop out to minimize risk and reporting burden. Therefore, the Centers for Medicare and Medicaid Services (CMS) should update “Extreme and Uncontrollable Circumstances” policies for alternative payment models to reflect today’s reality, and private payers should follow suit. Meanwhile, health systems should creatively leverage their existing population health resources to address COVID-19 challenges.