Recently our firm was retained by a Private Equity firm to access the ACO market and two potential acquisitions that provide ACO outsourced services and Health Care IT solutions.

Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP) have a special, limited opportunity to innovate.   Waivers exempting MSSP ACOs from certain legal requirements and other benefits enable MSSP ACOs to experiment within certain limits.    The Medicare Shared Savings Program requires 33 measure that must be self-reported by the ACO to CMS. After  a limited period, self-reporting will not be allowed and third parties will be required to perform reporting.

The “MSSP 33” present interesting analytic opportunities, in particular for new cloud based analytics firms who provide flexible, low initial capital outlay to get started using Software as a Services (Saas) business models.  The MSSP 33 will be impacted by ICD-10 and other changes to data standards in healthcare within the next 12 months.

According to the Centers for Medicare and Medicaid (CMS), as of May 2014 there were 338 ACOs in the MSSP program with 4.9 million beneficiaries. Seventy two percent (72%) were in metropolitan areas.

ACOs were split into these categories:

  • Networks of Individual Practices
  • Group Practices
  • Hospital / Professional Partnerships
  • Hospital employing ACO professionals
  • Federally Qualified Health Center
  • Rural Health Clinic
  • Critical Access Hospital
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