(ii) an ACO whose participation contract has been terminated in accordance with the provisions of p. 425.218 or p. 425.220. Outcomes-Based Contracting. As a precondition for participation in the Next Gen model, next Gen ACOS is required to essentially perform “results-based contracts” with other payers such as commercial health plans, government Medicaid programs and self-insured employers. More than 50% of the total patients of a Next Gen ACO must be covered by a contract based on results before the end of the first year of performance. The CMS defines “results-based contracts” as such, including common financial savings and/or risks, patient experience assessments and meaningful quality incentives. Although pioneer ACOS already needs results-based contractual initiatives, the integration of results-based contractual requirements into the next Gen ACO model appears to be part of a broader trend, where Medicare is increasingly focusing on private payment agreements as an instrument to accelerate the introduction of new models of care and payment delivery. For example, the new CMS Oncology Care model also promotes models that engage multiple payers. Favorite suppliers and affiliates. Next Gen ACO provides an opportunity to work with health care providers who are not next-generation providers but can nevertheless contribute to the goals of a Next Gen ACO by facilitating its care coordination activities. The next gen ACO model defines three new types of suppliers with which or with which a new Gen ACO may have relationships: “Preferred Suppliers,” “Capitation Affiliates” and “SNF Affiliates.” 1. The ACO is the same legal entity as a recent or previous COA that participates in or participates in a performance-based Medicare ACO initiative within the meaning of this section, or who has participated in a second period of agreement for the shared insurance program under a bilateral model.

425.200 (e). Focus on Medicare Provider/Suppliers. “ACO participants” – individuals or groups of Medicare providers/providers identified by a single Medicare-registered tax identification number are the linchpins and strengths of the MSSP model.