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Tag: Medicare Shared Savings Program

Medicare Vies To Keep ACOs On Board With More Flexible Rules

More flexibility is coming for Medicare accountable care organizations under a final rule the CMS published Thursday (PDF). The revisions are intended to strike a balance between maintaining the program’s rigor and making sure providers continue to participate.

The Medicare Shared Savings Program will offer a new track to take on more financial risk of patient care, and it will allow Medicare ACOs to avoid penalties beyond the initial three-year term. The CMS will also issue future guidance on benchmarking and rebasing issues that have been sources of contention for many providers.

The Affordable Care Act catalyzed the creation of Medicare ACOs, which are networks of hospitals and physicians that aim to improve the quality and lower the cost of care for Medicare beneficiaries in a defined area. More than 400 ACOs participate in Medicare accountable care contracts, and they care for more than 7 million beneficiaries.

The CMS received 275 comments from concerned stakeholders, and the agency expects 90% of Medicare Shared Savings ACOs will stay with the program because of the rule changes.

Hospitals and physicians have been able to choose between two tracks for shared savings for ACOs, and the CMS is finalizing the third option it proposed in December. The third track is “very much modeled” after the Pioneer ACO, CMS Deputy Administrator Sean Cavanaugh said. And it also shares many similarities with the Next Generation ACO model that the CMS proposed in March.

Providers opting into track three will take on more financial risk, but could also share in potentially higher savings. The CMS said upside and downside risk for this model will be 75%—meaning an ACO’s bonus or penalty would be 75% of its savings or loss— just as it proposed in December. ACOs in track three are also given a fixed population of beneficiaries to care for.

Read the full report here.

Contact Steven G. Cosby, MHSA, Group Health Insurance Broker and Agent with Cosby Insurance Group, with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Growth And Dispersion Of Accountable Care Organizations In 2015

In January, an additional 89 provider organizations joined the Medicare Shared Savings Program (MSSP) as accountable care organizations (ACOs). While this year’s new entrants are a smaller cohort than those that joined in 2013 and 2014, they represent a continuation of the expansion of the accountable care movement.

The recent Department of Health and Human Services (HHS) announcement of its goal to move 50 percent of Medicare payments to alternative payment models (including ACO-based arrangements) indicates the government’s strong backing of the model and, coupled with continuing endorsement of the approach from state Medicaid programs and commercial insurers, there is strong support for this care delivery approach to continue.

In an ACO, health care providers accept responsibility for the cost and quality of care for a defined population. Each ACO’s laudable goal is to achieve what Don Berwick has called the “triple aim” — to improve quality, increase patient satisfaction, and lower costs. The key to reaching those goals is to change how providers are paid, based on reaching certain cost and quality benchmarks. In effect, the objective is to change incentives so that it is in providers’ best interest to maximize health, rather than focus on increasing the volume of services rendered.

ACO Growth

Leavitt Partners has been actively tracking ACOs since 2010, maintaining a database that is updated regularly from publicly available information and personal and industry interviews. Over the past year, approximately 120 organizations have become ACOs in public and private programs, bringing the total to 744 since 2011 (Figure 1). The historical ACO growth data shown in Figure 1 are slightly different from our past estimates, as they are now based on the start date of the ACO’s contract, not on when the ACO was announced.
For example, the 89 ACOs announced in December 2014 are listed as beginning in January 2015, which is the start of their contract. Regardless of how many contracts an ACO is engaged in, both public and private, an ACO is counted only once. Note that some of the new Medicare Shared Savings Program participants already had commercial contracts, and are thus tracked beginning at the start of their first contract.

Figure 1

In addition to growth in the total number of ACOs, there has been continued growth in the number of people covered by ACO arrangements. Since the start of 2014, an estimated 4.5 million more people have been included in accountable care arrangements, bringing the total to 23.5 million covered ACO lives (Figure 2). Of these, only 7.8 million are part of the Medicare ACO programs (Pioneer and Medicare Shared Savings Program), meaning that the majority of ACO volume is coming from the commercial and Medicaid sectors.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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