"They don’t get paid on how much they save, because we can’t tell that," she says. "If they don’t meet the benchmarks, they go into remediation and, if that's not successful, they leave. Every community has one vote in the ACO."
Caravan is urging participants that are ready to take risk to move forward because it's potentially more lucrative.
"We’re aggregating all these participants under one umbrella, so they can get reliable performance. But the bigger thing is that CMS is giving great rewards to those who are willing to take risk."
The collaborative ACO with one-sided risk that Winona Health will be joining won't be its first foray into Shared Savings.
Its current ACO is in the third year of its three-year contract; the new ACO should have six in-state partners. Schultz says to get to 100,000 lives, the new ACO may add organizations in neighboring states.
"It's a virtual model, so it doesn't particularly matter if they're all in the state. It's not a requirement," she says.
The application with CMS is due in July to begin a contract in January 2019.
Beyond the collaborative ACO model, Schultz is hopeful the health system's demonstrated success in Medicare ACOs has the potential to jump-start value-based negotiations with commercial payers.
"We have changed the standard of care and we've been doing it across the board—prevention, wellness, management of chronic conditions—so now we have results we can show the rest of our payers. We've found the needles in the haystack."
Philip Betbeze is the senior leadership editor at HealthLeaders.