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next generation aco

nxt_gen_aco
quality·Updated Jun 23, 2026

Definition

ISO-11179 Definition

An advanced CMS ACO model that offered higher shared savings rates and broader financial risk than the Medicare Shared Savings Program in exchange for accepting greater downside risk and participating in more innovative payment mechanisms including population-based payments. Next Generation ACO participants could receive monthly population-based payments rather than standard fee-for-service reimbursement, enabling more flexible care delivery including telehealth, home visits, and skilled nursing facility care beyond standard Medicare coverage. The model tested whether ACOs with more experience in value based care could thrive under more aggressive risk arrangements.

CMS concluded the Next Generation ACO model in 2021 and transitioned participants into successor direct contracting and ACO REACH models. Healthcare data teams supporting next generation ACO participants built sophisticated population payment reconciliation systems that tracked actual utilization against population payment amounts, calculated quarterly settlement payments, and modeled risk sharing under the benchmark-based performance payment methodology.

Standard Abbreviation

nxt_gen_aco

Category

quality

Production DDL — FACT_QUALITY_MEASURE

FACT_QUALITY_MEASURE.sql
CREATE OR REPLACE TABLE FACT_QUALITY_MEASURE (
    qlty_key        INTEGER        NOT NULL  -- surrogate key,
    mbr_key         INTEGER        NOT NULL  -- FK to DIM_MEMBER,
    plan_key        INTEGER        NOT NULL  -- FK to DIM_PLAN,
    meas_yr         SMALLINT                 -- measurement year,
    hedis_meas_cd   VARCHAR(20)              -- HEDIS measure code,
    denom_ind       CHAR(1)                  -- denominator eligible,
    numer_ind       CHAR(1)                  -- numerator met,
    excl_ind        CHAR(1)                  -- exclusion indicator,
    gap_open_ind    CHAR(1)                  -- care gap open,
    star_rtg_nbr    DECIMAL(3,1)             -- star rating,
    qlty_scr        DECIMAL(5,2)             -- quality score,
    perf_thrsh_pct  DECIMAL(5,2)             -- performance threshold,
    raf_scr         DECIMAL(10,3)            -- risk adjustment factor,
    outreach_cnt    SMALLINT                 -- outreach attempts,
    load_dt         TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

Standard Snowflake DDL for the canonical quality table. Convert to BigQuery or Databricks →

Why This Term Matters

Quality measure data determines how payers and providers are rated and reimbursed under CMS Stars, HEDIS, and value-based care contracts. Data engineers who understand quality terminology build measure calculation pipelines that correctly attribute patients, apply denominator exclusions, and flag documentation gaps before submission deadlines. Incorrect quality data directly affects star ratings, pay-for-performance bonuses, and Medicare Advantage plan bids.

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