5 changes to help Medicare ACOs thrive

Despite the rapid growth and early successes of accountable care organizations (ACOs), the Medicare Shared Savings Program (MSSP) must make some key changes to fully realize the model's potential, argues a Health Affairs blog post.

Medicare ACOs have made progress on care quality and patient experience, but only 1 in 4 MSSP ACOs has reduced spending enough to share in overall savings, write Mark McClellan, Ph.D., Ross White of the Brookings Institution and Lawrence Kocot of Epstein Becker & Green.

In December, the Centers for Medicare & Medicaid Services (CMS) unveiled a proposed rule that, among other provisions, would delay financial penalties an additional three years for struggling ACOs, but several other reforms are necessary for more meaningful success, the authors write, including:

Increased certainty: Uncertainty within MSSP is a major concern among Medicare ACOs, due to factors such as the methods used to determine their financial benchmarks. The way this methodology incorporates patient health variations may be too restrictive to accurately gauge quality and financial improvements, according to the post. To correct this, CMS should transition to a benchmark calculation formula that combines ACOs' historical spending and regional spending, and eventually transition to a benchmark based entirely on regional spending.

Clear definition of the transition away from fee-for-service: The authors acknowledge the helpfulness of CMS' proposal to facilitate the transition and waive some fee-for-service reimbursement requirements, but disagree with the notion of separate "tracks" for the transition. Instead, they write, CMS should drive the transition with incentives greater than those expected in the fee-for-service model for organizations that demonstrate reduced costs and improved quality.

Alignment of MSSP with other Medicare reimbursement programs: To get MSSP and other Medicare alternative payment models on the same page, the authors recommend risk adjustment calculations, reporting mechanisms and requirements, and consistent quality measures. Furthermore, Medicare should ease the process by which ACOs participate in multiple reform models.

Patient engagement: ACOs need increased support to communicate and engage with their patients, for which the authors suggest expanding the Center for Medicare & Medicaid Innovation's pilot program for Pioneer ACOs' "attestation models."

Use of pointers from commercial ACOs: Many ACOs in the private sector have seen greater innovation than those under the Medicare umbrella. Commercial ACOs have led the shift away from fee-for-service with limited financial risk, the authors write, and CMS "should seek to reinforce those successful steps."

To learn more:
- read the post