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Health care providers looking to explore or expand their involvement in value-based care through affiliation with an accountable care organization (ACO) have a large number of options available to them. In the Medicare space, many providers find themselves being courted by ACOs participating either in the Medicare Shared Savings Program (MSSP), or the recently implemented ACO Realizing Equity, Access, and Community Health (REACH) Model. Programmatic rules and statutory requirements dictate that providers can only ultimately participate in one of these two models. Providers, then, when faced with a choice of competing ACO proposals, must evaluate which model and partnership bests fits their clinical, operational, and financial goals.
There are a host of considerations that providers will be faced with when making this choice. For example, providers will need to assess their ability to take on risk, evaluate their anticipated attributed patient population and likely benchmarks, review cultural and clinical alignment with other participating and preferred providers within the prospective ACOs, and assess compatibility with quality and performance metrics used within the ACO, among a host of other matters.
While many of these considerations will be assessed within business, financial, and leadership teams and may not involve active participation of legal counsel, there are a number considerations when making this choice that touch on regulatory and other legal issues. This alert briefly touches on five such considerations, and a companion white paper, available [here], dives into these five consideration in greater detail.