Owning the Benefits of the Medicare Shared Savings Program

The Centers for Medicare & Medicaid Services (CMS) just released the Medicare Shared Savings Program (MSSP) application form and timeline for accountable care organizations (ACOs) looking to participate or renew participation in January 2021.

Key dates are:

• 2021 Non-binding Notice of Intent to Apply: Opens on April 20, 2020 and is due May 8, 2020 at 12:00 p.m. (noon) Eastern Time (ET)
• 2021 Initial and Renewal Applications: Opens on May 14, 2020 and closes on June 11, 2020 at 12:00 p.m. (noon) ET

With looming deadlines afoot for a program that could mean future success or duress for health systems, there are a few important things leaders need to know.

MSSP ACOs are taking control of the premium dollar.

MSSP accountable care organizations (ACOs) are reducing Medicare spending and increasing quality. In fact, participants achieved nearly $740 million in savings in 2018. Moreover, the National Association of ACOs has reported that MSSP ACOs saved a gross $1.8 billion, nearly double the amount CMS reported in performance years 2013 through 2015.

It is evident that MSSP ACOs are making real progress. The benefit for health systems that participate is that they have the ability to own the design and financial success of the new care delivery and payment models that are required for this program. In essence, MSSP ACOs have control of the premium dollar because they own the payment model.

However, this means that health systems that choose not to participate in the program but operate in markets where competitors, payers and other physician-organizing entities are participating could be missing an opportunity for sharing in the savings generated for their very own patient populations. Getting to market ahead of these organizations is a strategic imperative for health systems. Deciding not to participate places the system’s hospitals at risk, as they will be viewed as cost centers by other ACOs and a means to generate savings via reduced utilization.

The days of no risk are over.

The Pathways to Success program has tacked on to similar value-based payment programs, such as the Bundled Payments for Care Improvement Advanced model, to give everyone in healthcare a simple message. This administration will continue to shift risk from government payers to private entities, meaning everyone has a decision to make – and fast.

Savvy businesses want to be organizers of alternative payment models because they see the opportunity for profitability and want to control the premium dollar. But health systems are best positioned to succeed in owning these models because they can control the integration of care delivery processes better than a third party.

Hospitals and health systems have been leaders in building and implementing innovative ways to improve health and promote value-added care, including enhancing quality and reducing the total cost of care. Successful ACOs and alternative payment models, such as bundled payments, are a powerful means to increase revenue, manage costs and get better reimbursement for these advancements.

There are multiple advantages to being a MSSP ACO.

As the broader value-based payment landscape rapidly evolves, it is high time for healthcare providers to participate in these models, not only for financial success, but also to stay competitively viable by building essential capabilities for the future.

The MSSP also:

• Supports high performance in the Quality Payment Program (QPP) by participating as a Merit-based Incentive Payment System (MIPS) Alternative Payment Model (APM) – a MIPS-APM.
  • This designation reduces administrative burden and provides advantageous scoring.
  • An ACO provides the most inclusive platform for supporting multiple provider types for the QPP.
• Positions health systems for greater alignment with independent clinicians in their markets.
  • The MSSP provides multiple fraud and abuse rule and payment waivers for working closely with independent clinicians.
  • It also allows health systems to get out ahead of disruptors (like Aledade and Privia), which are organizing independent clinicians to create ACOs and potentially use hospitals as a cost center.
• Provides access to a robust claims data set (Parts A, B and D data for assigned Medicare population).
  • The MSSP provides an incredibly robust data set, which can help health systems understand utilization patterns, including in-network and out-of-network utilization.
  • This data can also drive performance improvement opportunities.
• Allows for up to two years of non-downside risk to gain experience managing a population.
  • The MSSP can position organizations for the future of value-based reimbursement from multiple payers.

Whether or not the MSSP is the right fit, there are options for health systems that want to succeed in the future and Premier® can help.

To learn more about the Pathways to Success program or alternative approaches for success:

• Listen to our webinar.
• Hear how Southeastern Health Partners is doing it.