In 2015, the Northwell Health ACO chose to participate in the Medicare Shared Savings Program, with an effective start date of January 1, 2016. The Northwell Health ACO is governed by independent physicians, Northwell Health employed physicians, and a Medicare FFS beneficiary.
Northwell Health’s participation in the Medicare Shared Savings Program presents an opportunity to develop innovative approaches to health care delivery, streamline existing value-based programs, and promote wellness that will improve the health of our communities.
What is a Medicare Shared Savings Program ACO?
A Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) is a new, national approach to health care delivery for Medicare fee-for-service (FFS) beneficiaries. Created under the 2010 Patient Protection and Affordable Care Act, a MSSP ACO works to improve quality and reduce unnecessary costs.
MSSP ACOs are not managed care organizations, do not use closed networks of providers, and do not limit a Medicare beneficiary’s ability to seek care from participating Medicare providers outside an ACO.
There is no financial downside risk or disruption to underlying Medicare fee-for-service billing. When an MSSP ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.
For general questions or additional information about Accountable Care Organizations, please visit www.medicare.gov/acos.html or call 1-800 MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048.
Our mission
The Northwell Health ACO’s mission is to improve the health and wellness of the community through the collaborative efforts of physicians and other healthcare providers who:
- Share a commitment to the provision of excellent healthcare services; and
- Seek to enhance delivery of quality, coordinated and efficient care.
The Northwell Health ACO provides an opportunity to collaboratively improve patient outcomes by:
- Providing better coordinated care for our patients;
- Improving the health of the communities we serve; and
- Eliminating unnecessary costs in health care.
Northwell Health ACO annual compliance training (for participants only)
Participation Waiver Disclosure
The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain federal fraud and abuse laws that may otherwise limited innovation by ACOs participating in the Medicare Shared Savings Program (“MSSP”). See Final Waivers in Connection With the Shared Savings Program, 79 Fed. Reg. 62356 (Oct. 17, 2014) (“Interim Final Rule”). Pursuant to the Interim Final Rule, North Shore-LIJ MSSP ACO, Inc. (the “ACO”) seeks waiver protection for the arrangement described below:
In connection with the implementation of the ACO in 01/2016, the ACO has entered into an agreement with Northwell Health to provide a broad range of necessary management services and operational personnel to support the ACO’s operations as an ACO in the MSSP. Under the arrangement, the ACO shall compensate Northwell Health from any shared savings payments for its provision of management services, including but not limited general day-to-day operational personnel and services, financial management and accounting services, and credentialing.
The ACO’s governing body, consistent with its obligations under 42 C.F.R. § 425.106(b)(3), has made and duly authorized a bona fide determination on August 23, 2016 that the arrangement is reasonably related to the purposes of the MSSP, including, specifically, promoting accountability for the quality, cost, and overall care for a Medicare population and aiding the ACO in managing and coordinating care for Medicare fee-for-service beneficiaries.
Posted: August 23, 2016
Resources
Quality Payment Program
Upcoming Webinars and Programs
Provider Resources for New Medicare Cards
Beneficiary Resources for New Medicare Cards
Northwell Health ACO Poster Template: must be publicly displayed in all ACO participant offices
Beneficiary Information Notification: must be distributed to beneficiaries at or before their first primary care visit of the Performance Year and once again at the second primary care visit or 180 days following the first date of service, whichever is sooner
Spanish Northwell Health ACO Poster Template
Spanish Beneficiary Information Notification
Medicare Shared Savings Program Beneficiary Notification and Education Guidance
Beneficiary Information Notification FAQs
Beneficiary Fact Sheet
Voluntary Alignment Fact Sheet for Providers
Voluntary Alignment Fact Sheet for Beneficiaries
Spanish Voluntary Alignment Fact Sheet for Beneficiaries
Code of Ethical Conduct