Tag Archives: CMS

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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The Triple Aim, Well Two Out of Three… Really is Bad

One of the Triple Aim‘s has gotten lost. Will anyone in the healthcare sector publicly declare that they are in fact working on the Double Aim?

The Triple Aim, that lofty set of goals that the healthcare system claims to have embraced:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and.
  • Reducing the per capita cost of health care.

I agree with them and believe they are appropriate and necessary.

Everyone it seems, Continue reading

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Alternative Payment Models: Yeah or Nay?

So where do we go with our healthcare system under the new administration? Will we move to Alternative Payment bundled-paymentsModels or will FFS continue? A recent study showed that bundled payments for orthopedic joint replacement appeared to be working at lowering costs while maintaining quality.

At the same time, it seems that Dr. Tom Price, the nominee for Secretary of HHS is not a fan of bundled payment.

Along with Gregg Masters and Doug Goldstein, we’ll be exploring some of these and many other issues about the next phase of healthcare reform during the coming months on PopHealth Week.

Let us know what you think.

 

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PopHealth Week is a Production of Health Innovation Media and Accountable Health, LLC.

 

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Arien Malec of Relay Health/McKesson at HiMSS 16 Discusses Interoperability and More

One issue of key importance discussed over and over at HiMSS was Interoperability. Arien Malec,  VP, Data Platform and Acquisition Tools at RelayHealth / McKesson joined me at HiMSS 16 to discuss RelayHealth and his work in this area. Arien is involved at a national policy level as a Co-Chair of the Health IT Standards Committee  and a member of the Interoperability Standards Advisory Task Force.  In this interview for Health Innovation Media Arien touches on a number of important topics including interoperability, HL7 FHIR, patient access to their medical records and McKesson’s recent participation in the White House Precision Medicine Initiative.

 

 

You can follow on twitter @RelayHealth @McKesson_HIT @McKesson

 

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PopHealth Week June 3 – Sun Health Care Transitions Program

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Listen to a recording of the show with Jennifer Drago here:

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PopHealth Week airing Wednesday June 3 at 12 pm eastern will feature Jennifer Drago, EVP of Population Health at Sun Health. This week’s show will focus on some of the innovative programs  that Sun Health offers in the seniors market including their Care Transitions  Program which has a CMS Community-based Care Transitions Program       (CCTP) contract. CMS just renewed the Sun Health CCTP contract and  increased the number of patients to be managed.

The CCTP  “tests models for improving care transitions from the hospital to other settings and reducing readmissions for high-risk Medicare beneficiaries.” There are currently 72 sites participating in the CCTP pilot.

Per CMS:

  • Approximately 2.6 million seniors, or 1 in 5 are readmitted within 30 days
  • The cost of these readmissions is over $26 billion per year
  • The goal is to reduce readmission 20% per year
  • The program is to run for 5 years
  • The budget was estimated at $300 million over 5 years
  • To date 29 of the total 101 CCTP-funded sites have withdrawn or been ended

The CMS First Annual Report stated that of the 48 programs started in 2012 only four programs made statistically significant gains in reducing the ratio of readmissions to discharges from the participating hospitals.

But there is more to this story.

As with other CMS programs there are some concerns regarding the study methodology. The argument against the current methodology, which measures readmissions within 30 days as a percent of discharges may penalize hospitals, or communities that have worked to reduce hospital discharges in total. Because of the reduction in discharges, these initiatives may not show a reduction in 30 day readmits as a percent of discharges but would better reflect this changes by looking at a population based measure of readmissions.

http://www.medicaringcommunities.org/medicaring-blog-cms-cctp-metrics-have-seious-flaws/

http://medicaring.org/2014/12/16/protecting-hospitals/

http://www.n4a.org/blog_home.asp?display=16

Join us at PopHealth Week this Wednesday at 12:30 eastern as we discuss Sun Health and their innovative approach to Senior Health, Care Transitions and the CCTP program. Remember you can always listen download the show later if you can’t make the live broadcast.

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