Tag Archives: NAACOS

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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The Jefferson Population Health Colloquium – A Full Serving of Population Health

 

Population Health continues to be a major buzzword around the healthcare industry. At the recent HiMSS 17 conference in Orlando the talk of population health was everywhere from the vendor booths to the presentations, but where does one turn to get more than just the IT focus of population health? Where can one get a sense of the breadth and depth of population health from operations to policy, current status to future state,  provider implementations, data and analytics, patient engagement, in the weeds medication adherence and wearables to large community based initiatives? In other words where can one find a full serving of all that population health is?

That place is the Jefferson Population Health Colloquium, also in its 17th year.

This year’s event features keynotes ranging from the Future of Managed Care to Good Health is Good Business: The Results of an Innovative Alignment with Physicians and Communities.

Here are just a few of the many leaders providing keynotes this year include:

The balance of keynotes can be found on the program Agenda. The range and diversity topics covered is impressive.

Digging deeper into the Colloquium’s agenda we find ‘mini-summits‘ and ‘concurrent sessions’ on day two covering the following topics:

And concurrent sessions:

The most difficult part of this conference is deciding which sessions to attend. The complete agenda is available here, and a direct registration link for full details, here.

Also on Day two will be the awarding of the Hearst Health Prize For Excellence in Population Health now in its second year, this $100,000 prize goes to……..? Check out last year’s debrief of the winner ‘Community Care of North Carolina‘.

Tuesday evening closes with an optional dinner session, but one definitely worth attending to hear from Michael Dowling and Dr. Stephen Klasko on a panel moderated by David Nash MD, MBA.  This interesting and informative panel will discuss The Future of Clinically Integrated Networks a critically important component of creating a better health system and integrating population health.

I hope to see you there.

 

 

 

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