Tag Archives: ACO

ACOs and Value Based Care: The Best of Times Or The Worst of Times? It Depends!

By Fred Goldstein, MS and Gregg Masters, MPH

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.

Florida Association of ACOs

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 Models Navvis Healthcare, Kelly Conroy, Executive Director Holy Cross Physician Partners ACO, 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.

For registration details, click here.

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PopHealth Week Interview with Dr. Anthony Slonim of Renown Health

This week’s episode of PopHealth Week had a broad ranging and fascinating interview with Anthony Slonim, MD the President and CEO of Renown Health. We cover their community efforts, ACO, the Healthy Nevada Genetic Testing initiative which already has 35,000 people enrolled, value based care and other topics.

delivery models focused on improving health within the community. He is board-certified in Internal Medicine, Pediatrics, Internal Medicine Critical Care and Pediatric Critical Care and is an academic leader with faculty appointments as Clinical Professor in the Departments of Internal Medicine and Pediatrics at the University of Nevada, Reno School of Medicine. He also holds a master’s degree and a doctorate in Administrative Medicine and Health Policy from George Washington University Center for Health Policy Studies and has more than 100 publications and 15 textbooks to his name.

Since joining Renown Health in July 2014, Dr. Slonim has reoriented northern Nevada’s largest locally governed, not-for-profit healthcare network. He launched a five-year strategic plan that is focused on the community’s overall health while embracing the national triple aim initiatives of improving quality care and patient satisfaction — all while reducing costs. Dr. Slonim also ushered in a new era of national collaboration to establish a medical training campus at Renown and expanded the region’s quaternary care services in collaboration with Stanford Medicine.”

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Listen to Anthony Slonim, MD on PopHealth Week

Dr. Slonim is an innovator and proven leader in healthcare at both the regional and downloadnational levels. During his notable career, Dr. Slonim has developed a profile as an expert in patient safety, accountable care, healthcare quality and innovative care

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Interview with David Nash

I had a fascinating interview with David Nash, MD, Founding Dean of the College of Population Health at Jefferson. Our discussion included everything from Patient Centered David NashMedical Homes (PCMH), Accountable Care Organizations (ACOs), medical errors and unnecessary services, to value based care and of course population health.  As David said, perhaps its time for Doctors to “Look in the Mirror.”

There is so much going on in healthcare with the recent Amazon, Berkshire Hathaway and JP Morgan announcement to the CVS purchase of Aetna, all roiling the healthcare market. So what does it mean and where might we go for solutions?

Listen in.

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David Nash, MD on PopHealth Week 1/31/18

And if you want to hear from a plethora of experts in the Population Health Field attend this years Population Health Colloquium at Jefferson March 19 – 21 in Philadelphia.  You can learn more here.

PopHealth Week is produced by Health Innovation Media.

 

 

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PopHealth Week – This week we discussed Theranos, Healthways, ACOs and Precision Medicine

Listen to Doug Goldstein (@efuturist) Gregg Masters (@2healthguru) and me (@fsgoldstein) discuss the continuing Theranos Saga, The Healthways acquisition by Sharecare, Precision Medicine and the Cancer Moonshot and ACO results on PopHealth Week:

 

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Will we get to 50% Value Based Payments by 2018

Here was my response to the question from Xerox Healthcare at the recent HiMSS conference “Will we get to 50% value based payment by 2018 as stated by CMS?”

 

Thanks to Xerox Healthcare for the opportunity to provide my thoughts.

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