By RaeAnn Grossman

The MedPAC June 2019 report is out and Chapter 6 of the report to Congress shares MedPac’s review on the MSSP program.  As always, we invite you to read the full report and share your thoughts.  Let’s all remember that in 2018 there were 561 ACOs. The goal of ACOs is to improve coordination and quality of care, maintain the beneficiary’s choice of provider, and reduce unnecessary service use. ACOs may qualify for financial rewards or shared savings if the spending for their assigned patients is lower than the benchmark set by CMS. Therefore, an ACO’s performance relative to its benchmark is important to the ACO. In 2017, CMS reported that, on average, spending on ACO beneficiaries was sufficiently below the established benchmarks that many ACOs earned shared savings.

It is important to note the methodologies around:

  • Assignment or attribution
  • How shared savings is computed
  • How benchmarks are established

Overall the outcome, after several models were analyzed, is slightly slower spending but many ACOs received no bonus payment due to their poor performance or lack of cost savings.  Thus, we need to explore the size, geography, type, structure and the payment design for successful ACOs. The analysis indicates the people who leave or switch coverage from the ACO cause significant harm to the ACO’s success and the ability to calculate success properly. We, at DataLink, have designed payment support modules, network management, provider engagement approaches to ensure our ACO partners do well in controlling costs, and strategies to improve the health outcomes of patients.