Over the holidays the Centers for Medicare & Medicaid Services (CMS) gave us a present, even though it wasn’t entirely what we asked for. They finalized the redesign of the Medicare Shared Savings Program (MSSP), and announced a tight deadline for organizations interested in joining the program (effective July 1, 2019) to submit a non-binding notice of intent to apply for its next phase by January 18, 2019 at noon ET.
With looming deadlines afoot for a program that could mean future success or duress for health systems, there are a few important things leaders need to know.
MSSP ACOs are taking control of the premium dollar.
MSSP accountable care organizations (ACOs) are reducing Medicare spending and increasing quality. According to CMS, in performance year 2017, MSSP ACOs generated $314 million in net Medicare savings with 60 percent achieving savings – a 56 percent increase compared to 2016. And they did so with a mean quality score of 90.5 percent. Moreover, the National Association of ACOs has reported that MSSP ACOs saved a gross $1.8 billion, nearly double the amount CMS reported in performance years 2013 through 2015.
It is evident that MSSP ACOs are making real progress. The benefit for health systems that participate is that they have the ability to own the design and financial success of the new care delivery and payment models that are required for this program. In essence, MSSP ACOs have control of the premium dollar because they own the payment model.
However, this means that health systems that choose not to participate in the program but operate in markets where competitors, payers and other physician-organizing entities are participating could be missing an opportunity for sharing in the savings generated for their very own patient populations. Getting to market ahead of these organizations is a strategic imperative for health systems. Deciding not to participate places the system’s hospitals at risk, as they will be viewed as cost centers by other ACOs and a means to generate savings via reduced utilization.
The days of no risk are over.
The new MSSP “Pathways to Success” program has tacked on to similar value-based payment programs, such as the Bundled Payments for Care Improvement Advanced model, to give everyone in healthcare a simple message. This administration is shifting risk from government payers to private entities, meaning everyone has a decision to make – and fast.
Savvy businesses want to be organizers of alternative payment models because they see the opportunity for profitability and want to control the premium dollar. But health systems are best positioned to succeed in owning these models because they can control the integration of care delivery processes better than a third party.
Hospitals and health systems have been leaders in building and implementing innovative ways to improve health and promote value-added care, including enhancing quality and reducing the total cost of care. Successful ACOs and alternative payment models, such as bundled payments, are a powerful means to increase revenue, manage costs and get better reimbursement for these advancements.
Act now, don’t wait.
With only a few days left before the notice of intent to apply is due on January 18, there is no time to waste. Organizations that are thinking about participating in the MSSP for the first time, renewing their participation or moving to one of its new tracks early should fill out a notice of intent to apply. It takes less than 30 minutes and is nonbinding.
You’ll need to answer questions regarding:
- Your ACO’s legal entity information
- Your ACO’s track selection based on three main classifications
- SNF 3-Day Rule Waiver, Beneficiary Incentive Program and repayment mechanism information (for only those ACOs that are taking on downside risk)
- Early review of your ACO’s participant and/or SNF affiliate agreement (optional)
- Your ACO’s contact information
There are multiple advantages to being a MSSP ACO.
As the broader value-based payment landscape rapidly evolves, it is high time for healthcare providers to participate in these models, not only for financial success, but also to stay competitively viable by building essential capabilities for the future.
The MSSP also:
- Supports high performance in the Quality Payment Program (QPP) by participating as a Merit-based Incentive Payment System (MIPS) Alternative Payment Model (APM) – a MIPS-APM.
- This designation reduces administrative burden and provides advantageous scoring.
- An ACO provides the most inclusive platform for supporting multiple provider types for the QPP.
- Positions health systems for greater alignment with independent clinicians in their markets.
- The MSSP provides multiple fraud and abuse rule and payment waivers for working closely with independent clinicians.
- It also allows health systems to get out ahead of disruptors (like Aledade and Privia), which are organizing independent clinicians to create ACOs and potentially use hospitals as a cost center.
- Provides access to a robust claims data set (Parts A, B and D data for assigned Medicare population).
- The MSSP provides an incredibly robust data set, which can help health systems understand utilization patterns, including in-network and out-of-network utilization.
- This data can also drive performance improvement opportunities.
- Allows for up to two years of non-downside risk to gain experience managing a population.
- The MSSP can position organizations for the future of value-based reimbursement from multiple payers.
Whether or not the MSSP is the right fit, there are options for health systems that want to succeed in the future and Premier® can help. To learn more about the Pathways to Success program or alternative approaches for success, listen to our webinar or contact us.