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Seema Verma. Photo: Bill Clark/CQ Roll Call

The Trump administration has a message for accountable care organizations, a cost-cutting enterprise encouraged by the Affordable Care Act: You're either in or you're out.

The big picture: ACOs are one of the many efforts to get doctors, hospitals and other providers to work together — and get paid together — under the belief that greater collaboration will both save money and improve quality.

  • To that end, there were two initial models to entice providers into joining ACOs. One allowed them to share in whatever savings they accrued for Medicare.
  • The other track gave ACOs a bigger share of those savings, but only on the condition that they also accept financial penalties if they missed their savings targets.

The no-risk track is shrinking, the Centers for Medicare and Medicaid Services said yesterday. From now on, if you want to be in an ACO, you can only stay in the reward-only model for two years before accepting some risk. That's down from six years now.

  • CMS acknowledged that this will lead to a decline in participation, but it believes the remaining ACOs will be the ones that drive the biggest savings.
  • “There are successes — and there are successes when providers are wiling to take on two-sided risk," CMS Administrator Seema Verma told reporters.

Go deeper: Read the new rules, or read Verma's summary of the new rules in Health Affairs.

Go deeper

Federal judge orders Trump administration to restore DACA

DACA recipients and their supporters rally outside the U.S. Supreme Court on June 18. Photo: Drew Angerer via Getty

A federal judge on Friday ordered the Trump administration to fully restore the Deferred Action for Childhood Arrivals program, giving undocumented immigrants who arrived in the U.S. as children a chance to petition for protection from deportation.

Why it matters: DACA was implemented under former President Obama, but President Trump has sought to undo the program since taking office. Friday’s ruling will require Department of Homeland Security officers to begin accepting applications starting Monday and guarantee that work permits are valid for two years.

Updated 50 mins ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Politics: Fauci says he accepted Biden's offer to be chief medical adviser "on the spot" — The recovery needs rocket fuel.
  2. Health: CDC: It's time for "universal face mask use" — Death rates rising across the country — Study: Increased testing can reduce transmission.
  3. Economy: U.S. economy adds 245,000 jobs in November as recovery slows — America's hidden depression: K-shaped recovery threatens Biden administration.
  4. Cities: Bay Area counties to enact stay-at-home order ahead of state mandate
  5. Vaccine: What vaccine trials still need to do.
  6. World: UN warns "2021 is literally going to be catastrophic"
  7. 🎧 Podcast: Former FDA chief Rob Califf on the vaccine approval process.
2 hours ago - Health

Bay Area counties to enact stay-at-home order ahead of state mandate

Golden Gate Park. Photo: Justin Sullivan via Getty

Counties around the San Francisco Bay Area will adopt California’s new regional stay-at-home order amid surges in cases and ICU hospitalizations, health officials said Friday.

The big picture: California Gov. Gavin Newsom announced a three-week stay-at-home order on Thursday that would go into effect in regions with less than 15% ICU capacity. Despite the Bay Area’s current 25.3% ICU capacity, health officials from Alameda, Contra Costa, Marin, Santa Clara, San Francisco and the city of Berkeley are moving ahead with a shelter-in-place mandate in the hopes of reducing risk.