Use of voluntary alignment in the Next Generation ACO model

Area of Science:

• Healthcare policy
• Accountable Care Organizations
• Medicare

Background:

• Voluntary alignment in the Next Generation Accountable Care Organization (NGACO) model allows beneficiaries to choose their provider.
• Understanding adoption and use is crucial for refining future accountable care models.

Purpose of the Study:

• To describe the adoption and utilization of voluntary alignment within the NGACO model from 2016 to 2021.
• To identify factors influencing the use of voluntary alignment by NGACOs and beneficiaries.

Main Methods:

• Mixed-methods analysis combining cross-sectional survey, enrollment, and claims data.
• Qualitative analysis of coded interview transcripts from NGACO leadership.

Main Results:

• Widespread voluntary alignment adoption was limited across NGACOs.
• Voluntary alignment beneficiaries were sicker and more costly than those aligned by claims.
• NGACO leaders expressed satisfaction with claims-based alignment, questioning the value of increasing voluntary alignment.

Conclusions:

• NGACO leaders cited implementation effort, patient education needs, and administrative constraints as barriers to voluntary alignment.
• Perceived benefits included attribution flexibility and enhanced beneficiary engagement.
• Suggestions for improvement included year-round voluntary alignment sign-up to streamline workflows.