CMS Hopes to Entice More ACOs with Proposed Risk, Rewards Models

Attempting to attract more accountable care organizations (ACOs) to participate in the Medicare Shared Savings Program (MSSP) without fearing penalties, CMS has released a set of proposed rules with updated penalties and incentives, plus a third new model to attract providers to form ACOs, according to CMS officials.

The proposed rules are designed to strengthen MSSP by placing greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. The MSSP includes more than 330 ACOs in 47 states, providing care to more than 4.9 million beneficiaries in Medicare fee for service, CMS says.

In its first year, 58 MSSP ACOs held spending below their benchmarks by a total of $705 million and earned shared savings payments of more than $315 million. Another 60 ACOs had expenditures below their benchmark, but not by a sufficient amount to earn shared savings.

Among the adjustments CMS intends to make are the following:

  • Providing more flexibility for ACOs planning to renew their participation in the program. Many ACOs choose to enter the program under a one-sided risk model, where the organization participates in shared savings with the Medicare program, but does not take on additional performance-based risk. More experienced ACOs that are willing to share in financial losses in return for the opportunity for a higher share of savings may elect to enter a two-sided model. CMS is proposing to give ACOs the option of a longer lead time to transition to a two-sided performance risk model after their first agreement period. ACOs would have the opportunity to renew under the one-sided model for one additional agreement period. ACOs that enter the Shared Savings Program under the two-sided performance risk model would see no change.
  • Encouraging ACOs to take on greater performance-based risk and reward. CMS is proposing to create a new two-sided risk model, called “track 3,” which integrates some elements from the Pioneer ACO model, such as higher rates of shared savings and prospective attribution of beneficiaries—a list of assigned beneficiaries provided at the start of the performance year, and no further beneficiaries will be added to the list during the performance year.

The proposed rule reflects input from program participants, experts, consumer groups, and the stakeholder community at large.

Source: CMS , December 1, 2014

Profiting from Population Health Management: Applying Analytics in Accountable Care

Profiting from Population Health Management: Applying Analytics in Accountable Care provides both a primer in population health management (PHM), identifying the challenges and opportunities of a robust PHM program, and an advanced case study in the use of analytics in PHM from two industry leaders, Patricia Curran, principal in Buck Consultants’ National Clinical Practice, and Robert Fortini, vice president, chief clinical officer at Bon Secours Health System.

This entry was posted in Accountable Care Organizations, affordable care act, Care Coordination, Care Transitions, Elderly Care, Medicare and tagged , , , , . Bookmark the permalink.
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