ACO Participation Waiver

eBrightHealth ACO Waiver Protection Form

Program Name:               
Facility Participant coverage of Private Practice and FQHC Shared Losses per the Shared Savings or Losses Distribution Policy for Performance Years Beginning 2020 (the “Policy”)

Type of Waiver Utilized:
ACO Participation Waiver

All Parties Involved:      
ACO Facility Participants

ACO Practice Participants, including Private Practices and Federally Qualified Health Centers (“FQHCs”)

Date Program will begin:
January 1, 2020

Description of Arrangement:
To be successful eBrightHealth ACO must have a degree of control over total Medicare Parts A and B fee for service expenditures for eBrightHealth ACO’s assigned beneficiaries to promote complete accountability for a patient population and coordination of items and services under Parts A and B and to encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery.  That degree of control requires the participation of Practice Participants, including Private Practices and FQHCs, and Facility Participants. Private Practices have expressed the position that payment by them of an allocated share of ACO losses in the absence of the financial incentive related to the Advanced Alternative Payment Model will cause financial hardship resulting in termination of their participation in eBrightHealth ACO. The participation of Practice Participants, including Private Practices and FQHCs, and Facility Participants in eBrightHealth ACO is required to promote complete accountability for a patient population and coordination of items and services under Parts A and B and to encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery to be successful.  In recognition of the potential financial hardship and to promote participation in eBrightHealth ACO by Private Practices, each eBrightHealth ACO Facility Participant has entered in an agreement to assume financial responsibility for losses attributed to their affiliated Private Practices.  In addition, since FQHCs are restricted from participating in any participation agreements with downside financial risk, the ACO Facility Participants will also assume financial responsibility for losses attributed to their affiliated FQHC(s).

Purpose of Arrangement:
For Shared Losses, using the distribution methodology documented in the Policy, the ACO will distribute Shared Losses among its Facility Participants and Practice Participants in a manner facilitating maximum participation by Practice Participants, including Private Practices and FQHCs, and Facility Participants in the ACO, resulting in the ACO being able to support the three-part aim of the Medicare Shared Savings Program and achieve an incentive to restrain wasteful spending, by having the requisite provider constituents needed to achieve quality, efficiency and cost reduction goals of the Shared Savings Program.  The arrangement will also include a lower limit on losses for those Private Practices meeting the Financial and Quality Performance goals established by eBrightHealth ACO for the performance year further promoting achievement of the goals of the Shared Savings Program.  The arrangement will  further the goals and objectives of the Medicare Shared Savings Program and allow non-employed ACO Practice Participants the ability to continue participation with eBrightHealth ACO.

Items, services, facilities or goods covered by the arrangement:
Assumption of the financial responsibility by ACO Facility Participants of their affiliated Private Practices and/or FQHCs attributed shared losses.

Date and manner of the Governing Body’s Authorization:

Approved by the Board of Managers on 8/18/2020