Tag Archives: Gregg Masters

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: New Look, New Syndication Times

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:

 

PopHealth Week Banner Asset 15 (2)@3000px

You can follow @PopHealthWeek on twitter and look for the show tweet so you’ll know who’s on. Here’s an example:

Dr. Steve J. Schienman

And if you can’t listen to the broadcast on HealthcareNow Radio,  you can catch prior episodes anytime you’d like right here.

Thanks for reading and I hope you’ll tune in to PopHealth Week.

Coming up soon another fun project… PopHealth Minute.

 

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The Population Health Colloquium: Social Determinants of Health, Precision Medicine and the Triple Aim

By Fred Goldstein, MS and Gregg Masters, MPH*

 

The field of population health continues to grow and create new areas of exploration and integration. Population health practitioners are called upon to play a central role as health systems, health plans or healthcare organizations work to implement their strategies designed to improve health care quality, access, outcomes and cost while weaning the US Healthcare system away from its fee-for-service reimbursement paradigm.

From the emerging recognition that Precision Medicine is not antithetical to population health, to the development of unique approaches to address the social determinants of health, it’s an exciting time.

This year’s agenda for the Population Health Colloquium reflects the dynamic nature of the field, featuring leading healthcare experts from academia, healthcare systems, health plans, data and analytics companies, population health companies, regulators, innovators and entrepreneurs. Continue reading

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An Interview with Kaveh Safavi at HIMSS

Every year at HIMSS, Gregg Masters and I get a chance to sit down with Kaveh Safavi, MD Senior Managing Director, Head of the Global Healthcare Practice at Accenture. It’s become one of the meetings we most look forward to.  This year Kaveh discussed Accenture’s recently released Digital Health Consumer Survey and he also discussed a little bit about his thoughts on AI that he shared in a recent piece in Forbes.

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PopHealth Week – Annual Medicare Wellness Visit,Value Based Care and Employers

Gregg and I had an interesting discussion on this week’s episode of PopHealth Week. We covered the Annual Medicare Wellness Visit and how it came to be, as well as value based care and some interesting moves by employers (Walmart and the Utah State Employee Health Plan) and providers (Oschner and their ACO).  Listen in:

PopHealthWeek-logo-TWTTR-sq PopHealth Week – The Medicare Annual Wellness Visit, Oschner and Walmart, Utah Employees and high Cost Pharmaceuticals, a new approach.

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