I recently launched a new feature in conjunction with HealthCareNow Radio. Its called PopHealth Minute. These are one minute quick dives into issues, ideas and thoughts in Population Health. HealthCareNow Radio plays these episodes between shows, but you can access them anytime. Click on the image below to see the diversity of issues covered and listen to PopHealth Minute…
If there is a topic you’d like to hear covered, send me a note and I’ll attribute the topic request to you in the episode.
This past year has seen major changes to the Medicare Shared Savings Program (MSSP) that launched the huge growth in Accountable Care Organizations (ACOs) a principal workhorse in the transformational copy of the Affordable Care Act (ACA). It seems that the Center for Medicare and Medicaid Services (CMS) and the industry had a difference of opinion as to how successful ACO’s were under the original model, and of course CMS won.
The argument had to do with just how well the ACOs involved in the
Medicare Shared Savings Program Track one participants were doing. For
those new to this, the Track 1 model were the least risky model, with
most ACOs choosing this upside risk or shared savings only track which had a term of six years before they had to begin taking on two sided risk.
CMS looked at the 2016 data and was seeing limited savings
particularly with the overwhelming majority of participating ACOs
enrolled in this track. In May of 2018 Seema Verma (CMS Administrator) hinted at a new approach pointing to a study by Avalere that ACOs not only did not save money, but they have increased federal spending by $384 million,
versus a projected $1.7 billion in net savings from 2013 to 2016.
Couple this concern with the ongoing debate on whether Medicare
Advantage Plans (MAs) are still costing the Treasury (via over funding
or “up-coding”) vs. advancing the needle on the Triple Aim (better
experience of care, better outcomes at lower per capita costs).
Of course, the industry, led by the National Association of ACOs (NAACOs), were completely against this decision and stated that the ACOs had indeed saved money when they reviewed the 2017 results, which indeed showed net savings of $314 million dollars. NAACOS also stated that if these changes were made many ACOs would quit , pointing to a survey they had conducted showing that 71% of the ACOs in track 1 would quit if they had to take on 2 sided risk.
But by then it was too late and in last December CMS announced their new Pathways to Success models with the following by Seema Verma:
…the presence of an “upside-only” track may be
encouraging consolidation in the marketplace, reducing competition and
choice for Medicare FFS beneficiaries. While we understand that systems
need time to adjust, Medicare cannot afford to continue with models that
are not producing desired results.
The key changes were as follows:
Only 2 years before ACO must accept down-side risk
Beneficiaries notification of ACO participation at 1st primary care visit
Payment for tele-health services
Incorporates regional spending into ACO targets
Authorizes termination of ACOs with multiple years of poor financial performance
Could potentially save $2.2 billion in Medicare costs during the next 10 years
The new tracks and their “glide path” are as follows:
So what does this mean for ACOs?
What better place to figure this out than the Florida Association of ACOs annual meeting.
Florida has been leading the way in ACO participation and performance
and while this conference is in beautiful Orlando Florida in the fall,
the attendees and speakers are national so one can get a full view of the impact and what’s working.
For an update on market conditions including an overview of the annual conference from FLAACOS CEO Nicole Bradberry,listen here.
Attending the 2019 FLAACOs annual conference you’ll hear from Aneesh Chopra, President, Care Journey and former CTO of the United States opening the conference, followed by, you guessed it, a panel on MSSP ACO and Pathways to Success with Sheila Fusé, Vice President, Policy and Payment ModelsNavvis Healthcare, Kelly Conroy, Executive Director Holy Cross Physician PartnersACO, Travis Broome, Vice President for Policy and ACO Administration, Aledade a technology enable physician practice management company who recently reported some rather impressive results for 2018 from their network of clients ACOs.
The conference will then dig deeper exploring such topics as the new
CMS primary care contracting models, Social Determinants of Health
(SDoH), Direct employer contracting 2.0 and mental/behavioral health
from a rather packed agenda.
So, join us November 7th – 8th in Orlando Florida to network and learn from those getting it done in the ACO world.
Gregg Masters and I recently updated PopHealth Week to include a new look and new syndication times with HealthCareNow Radio. The weekly show still features the same great guests exploring all things population health and now you can listen to it syndicated on HealthCareNow Radio at 5:30 am, 1:30 pm and 9:30 pm Eastern Time. Take a look, here’s the new logo:
You can follow @PopHealthWeek on twitter and look for the show tweet so you’ll know who’s on. Here’s an example:
And if you can’t listen to the broadcast on HealthcareNow Radio, you can catch prior episodes anytime you’d like right here.
Her dedication, leadership, and passion have guided Numerof into its third decade of continuous growth and success.
From the firm’s inception, Rita has focused on developing new business models for companies in industries undergoing major market changes. Her work has spanned industries that are critical to global economic growth – financial services, healthcare delivery, pharmaceuticals, medical devices, telecommunications, and major industrial manufacturing. Bringing experience, style, and boundless energy, Rita has applied her expertise to help organizations create and execute successful new strategies in the face of fundamental market shifts.
‘Dr. Archelle Georgiou is a nationally recognized physician, advocate, advisor and author. She earned her medical degree from the Johns Hopkins School of Medicine and enjoyed practicing internal medicine in Northern California. However, wanting to have a broader impact on the healthcare system, she shifted her focus to the managed care industry. Between 1995 and 2007, she was a senior executive and Chief Medical Officer of UnitedHealthcare where she dismantled many of the company’s legacy policies in order to minimize the bureaucratic burdens imposed on patients and physicians.’
‘Since 2008, Archelle has served as a senior advisor for a diverse group of companies serving health needs in industries ranging from education to analytics and financial services to mining. She worked with former Speaker of the U.S. House of Representatives Newt Gingrich at his Center for Health Transformation, a non-partisan think tank focused on advancing patient-centric sustainable healthcare policies.’