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Overview

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What is an APM?

An Alternative Payment Model (APM) is a way to participate in Center for Medicare Medicaid Services (CMS) programs alternatively to the traditional Fee For Service (FFS) method of participation in CMS.

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What types of APM are most common among PCPs?

There are several types of APMs across provider types. The most common APMs that Elation Health providers participate in are the Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO), and ACO Realizing Equity, Access, and Community Health (REACH). An ACO is a type of an APM and may sometimes be used interchangeably. Note that there are different types of APMs, and different types of ACOs, understanding which program you are in is very important.

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How can I report quality as an ACO participant?

As an ACO participant, quality reporting often differs from traditional MIPS. Many ACOs have their own specific quality measures and reporting requirements, often tied to the overall performance of the ACO entity. These measures frequently emphasize patient outcomes and population health, rather than individual encounter-based metrics. Check with your ACO administrator for their specific reporting guidelines and data submission processes, as they often leverage electronic health record (EHR) data in different ways.

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How does ACO participation and MIPS overlap?

ACO participation can significantly impact MIPS. Qualifying APM Participants (QPs) may be exempt from traditional MIPS reporting. However, some ACOs, particularly non risk bearing MSSP ACOs, may still require quality reporting that aligns with MIPS measures. Furthermore, APCO participation can earn providers MIPS Alternative Payment Model (APM) scoring standards, which can positively affect their overall MIPS score. It’s essential to understand how your specific ACO interacts with MIPS to optimize your performance. This is why understanding your ACO contract and working with your ACO administrator on reporting requirements, scoring standards, and reimbursement expectations.

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What should I know about participating in an ACO as a provider or practice?

Participating in an ACO requires a commitment to collaborative care and data-driven decision-making. Providers must be prepared to share data, coordinate care across different settings, and focus on population health management. Understanding the specific financial risk and reward structure of your ACO is vital. Additionally, effective communication and engagement with patients are crucial for achieving positive outcomes. Be prepared to adapt your workflows and practice management to meet the requirements of the ACO. Some things a provider should know about participating in an ACO include:
  • What type of ACO are you participating in?
  • What are the terms of the contract?
  • Who is the ACO administrator?
  • What data are you as a provider responsible for and to whom?

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How can Elation Health help me participate in an ACO?

Elation Health offers a comprehensive EHR platform designed to support providers in ACO participation. Our platform facilitates seamless data sharing, quality measure tracking, and population health management. Elation’s robust reporting capabilities enable you to monitor performance, identify areas for improvement, and demonstrate value to your ACO entity. Features that aid in this include robust API capabilities, detailed reporting tools, and customizable workflows. By leveraging Elation Health, you can streamline your ACO participation and enhance your ability to deliver high-quality, coordinated care. The Medicare Shared Savings Program (MSSP) continues to evolve, bringing both opportunities and challenges for participating providers. In 2025, significant changes in quality reporting reshaped the landscape, demanding a deeper understanding of electronic Clinical Quality Measures (eCQMs), Clinical Quality Measures (CQMs), and the role of Qualified Clinical Data Registries (QCDRs).

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MSSP ACOs: A Distinctive Landscape

Unlike other ACO models like REACH, MSSP ACOs are directly regulated through CMS rulemaking, impacting Physician Fee Schedule and Quality Payment Program (QPP) updates. This direct connection means changes to outpatient Part B billing, MIPS, and MSSP ACOs are often intertwined.

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The 2025 Reporting Shift: eCQMs, CQMs, and the End of Web Interface

MSSP ACOs are incentivized to adopt eCQM reporting, though CQMs remain an option. Web Interface reporting is sunsetting, a sampling-based method that requires extensive chart abstraction. This shift necessitates a move from Medicare-only reporting to all-payer, all-patient reporting that aligns with MIPS eCQM standards.

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Technical Complexities and the Role of QCDRs

The move to eCQMs and CQMs introduces significant technical complexities. ACO administrators must grapple with data aggregation, deduplication, and reporting, often requiring the deployment of a QCDR. These QCDRs act as central hubs, collecting data from various practices within the ACO. This necessitates a strong understanding of technical feasibility and data exchange.

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Varied Reporting Pathways: A Challenge for Providers

The reporting landscape is far from uniform. Practices face diverse reporting requirements depending on their ACO. This variability arises from the ACO’s choice of reporting mechanisms, quality measures, and data sources. This means that a one-size-fits-all approach is impossible, and providers must work closely with their ACO administrators.

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Workflow Partners and Communication Pathways

Effective communication and collaboration are essential for successful reporting. Here’s a breakdown of the key players and their roles:
  • Practice → ACO Administrator- The practice enters a contractual agreement with the ACO administrator, outlining reporting obligations.
  • ACO Administrator → QCDR/Technical Solution - The administrator contracts with a QCDR or deploys their own technical solution to aggregate and report data.
  • ACO Administrator → Practice- The administrator communicates contractual obligations, including specific reporting requirements (e.g., 5 eCQMs, QRDA1 submissions, integrations). It is crucial to note that these requirements vary significantly between ACOs.
  • ACO Administrator → Elation Health - Ideally, the practice should communicate their reporting needs to Elation. However, sometimes the ACO administrator communicates on the practice’s behalf. Elation directs the ACO to the practice, and then the practice to Elation, to ensure the practice understands their requirements.
  • QCDR → Elation Health- The QCDR may directly contact Elation to establish technical requirements, integrations, and workflows. For instance, QCDRs like MD Interactive may establish FHIR integrations and provide guidance on QRDA1 file generation.
  • QCDR → Practice/Provider - The QCDR explains the technical solution and required workflows to the practice.

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Key Takeaways for Providers

  • Understand your specific ACO’s reporting requirements.
  • Embrace data sharing and collaboration with your ACO and QCDR.
  • Familiarize yourself with eCQMs and CQMs.
  • Leverage technology to streamline data aggregation and reporting.
  • Recognize the importance of clear communication with all stakeholders.