By NextBestFitPhase 3: Waves 2 & 3: working-age adults · Step 3.6
Create integrated care organizations (ICOs)
Years 2–4 · UHADiscuss this step
Every existing law, program, institution, or practice this step changes: what it is today, what happens to it, when, and what that costs or trades off.
| What | Today | Change | Trade-off |
|---|---|---|---|
| Medicare ACOs & CMS Innovation Center models amendedYears 2–4 Provider payment & regulation | Value-based payment experiments layered on fee-for-service. | ACOs can convert to integrated care organizations; the Innovation Center continues within UHA. | Keeps experimentation; ends shared-savings arrangements tied to MA and commercial contracts. |
| PACE (Programs of All-Inclusive Care for the Elderly) replacedYear 2 Federal programs | Capitated programs for frail elders eligible for nursing-home care, mostly dual eligibles. | Convert to integrated care organizations paid a risk-adjusted capitated budget. | Preserves a successful integrated model; small programs bear more administrative work to meet ICO rules. |
| ACA and Medicare Advantage risk adjustment amendedYear 4 Federal insurance & health law | Transfers between insurers based on enrollee health; drives coding intensity. | Ends for insurers; retained only for integrated care organization budgets, with audits. | Removes most of the upcoding industry; risk-adjustment gaming can still occur for ICOs. |