SPRING CONFERENCE RECAP

The NAACOS Spring Conference brought together nearly 900 accountable care leaders to discuss real-world AI use case studies, best practices for engaging specialists in accountable care, developing cross-payer strategies for accountable care, and so much more. We were pleased to be joined by several leaders from the Centers for Medicare and Medicaid Services, who highlighted how the agency is advancing accountable care, their vision for new models, approaches to fraud, waste, and abuse, and goals for the Health Technology Ecosystem Initiative.

Thank you to all of our speakers for lending your expertise and to our attendees for growing alongside us. We can't wait to see everyone on October 14–16 at the Marriott Marquis in Washington, D.C.!

NOW AVAILABLE: SPECIALITY ENGAGEMENT IN ACCOUNTABLE CARE TOOLKIT

NAACOS released the Specialty Engagement in Accountable Care Toolkit—a new resource designed to support meaningful specialty engagement across the continuum of care. The toolkit provides voluntary best practices, stepwise guidance, and practical tools that organizations can adapt based on their readiness and market dynamics. Download a free copy of the toolkit and resources on the NAACOS website. NAACOS will host a webinar on May 11 at 3:00 pm ET to review the toolkit and share key insights and best practices. Register for the webinar. 

HELP US ACCELERATE CARE TRANSFORMATION

ModernizeACOs.org is a central platform of key areas and advocacy important for advancing accountable care. The site includes resources and templates to jumpstart your advocacy efforts. In support of these issues, several NAACOS members authored a Health Affairs Forefront article outlining key recommendations for making the Medicare Shared Savings Program (MSSP) more competitive and aligned with Medicare Advantage to bring more beneficiaries into the program and take advantage of MSSP’s strong track record of cost savings and patient outcomes.

NAACOS FIGHTS TO PROTECT ACOS FROM FRAUD ON THE HILL AND IN LETTER TO CMS

Last week the House Ways and Means Committee held a hearing on Medicare fraud. President and COO of Palm Beach ACO David Klebonis’ testimony highlighted how ACOs identify suspicious activity through claims data but lack the tools and coordination needed to act quickly and protect patients.

Separately, NAACOS sent CMS a letter urging additional action to protect ACOs in MSSP from financial harm caused by egregious skin substitute spending and other fraud, waste, and abuse beyond their control. NAACOS will continue working with Congress and CMS to improve approaches to hold ACOs harmless for fraud, waste, and abuse outside of their control.

LEAD MODEL DETAILS AND RESOURCES

NAACOS is working to ensure that members are supported as they evaluate the LEAD (Long-term Enhanced ACO Design) Model. Join the monthly ACO REACH/LEAD Roundtable Meeting Series on the Fourth Thursday each month, noon ET, to engage in peer discussions on operating in the model. Register to join the series.

We also have several new resources:

• Pre-recorded Webinar: Provides a detailed overview of the model.

• ACO Comparison Chart: Outlines and compares MSSP, ACO REACH, and LEAD across several domains, including financial structure, beneficiaries and alignment approaches, quality, compliance programs, and available waivers.

• LEAD Model Detailed Slides: Presents comprehensive model details.

Additionally, CMS is hosting a LEAD Alignment and Financial Methodology Office Hour on May 5 at 2:00 pm ET. Register to attend.

NAACOS WORKS WITH HOUSE DOCTORS CAUCUSES ON PAYMENT REFORM

The House Republican and Democratic Doctors Caucuses are working on a bipartisan legislative framework to reform Medicare’s physician payment system. NAACOS has been meeting with the caucuses and providing feedback on how to incentivize and improve accountable care. The Doctors Caucuses are working on proposals to:

• Shift physician payments to reflect inflation while maintaining higher payments for APMs;

• Invest in primary care and address budget neutrality challenges that result in payment cuts; and

• Reform fee-for-service quality reporting and establish guardrails for Innovation Center models. 
  

LAWMAKERS CONSIDER FISCAL 2027 SPENDING

Congress has begun reviewing the President’s Fiscal Year (FY) 2027 budget request with committees holding hearings to examine proposed spending and policy priorities. At the same time, House and Senate Appropriations Committees are drafting FY 2027 spending bills that will ultimately determine government funding levels. With funding set to expire on September 30, Congress faces a limited window to pass appropriations legislation. An extension of current funding levels past the November mid-term elections is expected with most spending and health extenders discussions taking place during the lame-duck session of Congress (November–December).

BIPARTISAN MEDICARE ADVANTAGE LEGISLATION INTRODUCED 

A bipartisan group of lawmakers in the House and Senate introduced the Medicare Advantage Improvement Act. A section-by-section summary and bill text are available.

The bill:

• Updates the prior authorization and coverage determination process;

• Establishes a new compliance scoring program and expands star ratings;

• Requires prompt payment for authorized services and limits post-authorization denials;

• Codifies the two-midnight rule and aligns coverage with fee-for-service; and

• Improves network adequacy standards for post-acute services.

NAACOS continues to engage with our members about MA and payer alignment with VBC. Please send comments or feedback to [email protected].

CMS PROPOSES CJR-X MODEL

CMS has proposed the Comprehensive Care for Joint Replacement Expanded (CJR‑X) Model, a mandatory, nationwide expansion of episode‑based payment for hip, knee, and ankle replacements beginning October 1, 2027. For more details, register for the upcoming NAACOS CJR-X Model Overview webinar on May 6 at 12:00 pm ET.

FOURTH SNAPSHOT OF AAPM STATUS AVAILABLE

CMS recently announced it has updated the Quality Payment Program Participation Status Tool based on the fourth snapshot of APM data. The fourth snapshot includes data from Medicare Part B claims with dates of service between January 1, 2025, and December 31, 2025.

ENGAGE WITH YOUR REGION’S QUALITY IMPROVEMENT ORGANIZATION

CMS contracts with Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to work with hospitals, nursing homes, and outpatient clinical practices on improving health outcomes, health care quality, access, and value for Medicare beneficiaries. QIN-QIOs are expert groups that provide technical assistance, education, and data-driven tools at no cost to help health care providers improve processes and outcomes. Practices have until May to enroll, and the time commitment and types of support can be tailored to the practices’ needs. Learn more in this fact sheet and connect with the QIN-QIOs in your regions:

1.  Northeast: IPRO (Island Peer Review Organization)

2.  Mid-Atlantic: IPRO

3.  Southeast: HQI (Health Quality Innovators)

4.  Great Lakes: Superior Health

5.  Southcentral: TMF Health Quality Institute

6.  Midwest: Telligen

7.  West: HSAG (Health Services Advisory Group)

Contact Alyssa Neumann with questions about the QIN-QIO scope of work or to be connected with your local QIN-QIO.

FIRST NAACOS INNOVATION SPOTLIGHT: AI EDITION WITH URSAHEALTH

Join us for the first in our Innovation Spotlight series – AI That Delivers: Transparent and Defensible Population Health Opportunity Identification – sponsored by UrsaHealth. Not all opportunities are created equal. Not all AI analyses effectively avoid hallucinations to identify valid opportunities. This session will focus on how deliberately designed AI can help prioritize high-impact areas by combining clinical, financial, and utilization data to support more targeted population health management strategies, while still maintaining trust and transparency in the underlying methodology. This event will be held on May 12 at 2:00 pm ET, and participation is free for members and non-members from ACOs and other value-based care organizations. Register here.

LEARN TOGETHER AT MAY 19 SOUTHWEST VIRTUAL MEETING 

Join others in the region and gain valuable perspectives, real world examples, and make lasting connections. Topics will include balancing access, utilization, and quality in risk-based contracts, as well as strengthening community care hub partnerships across the Southwest. Registration for virtual regional meetings is free to members and non-members from ACOs and other value-based care organizations.

SIMPLIFYING COMPLIANCE: DON'T MISS THE 2026 MANUALS

Purchase today! NAACOS is proud to continue its partnership with Wilems Resource Group to deliver the newly updated 2026 Compliance Manuals. In an environment where regulatory expectations are constantly evolving, having clear, reliable guidance is more important than ever. These updated manuals are designed to help organizations stay aligned with current requirements while simplifying the complexity of compliance.

GET INTO SHAPE THIS SUMMER WITH BOOT CAMP 101

Looking to build your understanding of ACO analytics? Join NAACOS for the Boot Camp 101 virtual event, June 2–4 from 1:00–5:00 pm ET with time each day for peer discussion.

Boot Camp 101 is ideal for beginner to intermediate learners; this program helps newer ACOs and team members strengthen core skills in value-based care, data, and analytics. Topics include ACO data requirements, analytics resources, provider reporting, MSSP and LEAD reporting, attribution, care management metrics, and more. Attendees will gain practical insights and valuable peer connections to support future success.

• The Administration for Community Living (ACL) has launched the Health at Home Challenge to support dually eligible Medicare and Medicaid beneficiaries with complex needs. This initiative focuses on scaling advanced Community Care Hubs (CCHs) that integrate clinical care and community-based services to support individuals in their homes.

• This recent AJMC commentary highlights a fundamental shift in how MA agencies approach utilization management, specifically regarding prior authorization for drugs. This article emphasizes that the proposal is not incremental; rather, it expands earlier prior authorization reforms to include drug prior authorization, requiring payers to support electronic, interoperable workflows for both medical and pharmacy benefit drugs.

• A recent Health Affairs article analyzes the Medicare Advantage Star Ratings program and finds that most quality score improvements over the past decade were driven by a small number of medication-related and clinically focused measures. In this study between 2015 and 2025, medication reconciliation and therapy management measures accounted for more than one-third of all rating improvements.