Farzad Mostashari: CMS should look to Medicare Advantage to improve accountable care

CMS could improve ACOs with a little help from Medicare Advantage. (Pixabay)

HHS Secretary Alex Azar has made it clear that the transition to value-based care is one of his priorities, and if the agency wants to improve accountable care organizations it should look to Medicare Advantage for inspiration. 

Aligning ACOs with MA to a greater degree could boost enrollment and pay off for both providers and patients, according to a NEJM Catalyst blog post from Farzad Mostashari, M.D., CEO of Aledade, Inc., a firm that supports primary care providers who want to start ACOs, and Travis Broome, Aledade's vice president of policy and ACO administration. 

Department of Health and Human Services head Azar has said the agency will focus on furthering the industry's transition to value-based care. At an America's Health Insurance Plans event he said he wanted to work alongside payers to achieve that goal. 


2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

CMS has also put a spotlight on easing the administrative burdens providers face as part of its "Patients Over Paperwork" initiative

The Centers for Medicare & Medicaid Services has admitted that the benchmarks it uses for ACOs can be complicated, so tying those benchmarks to a methodology based on MA would be a simpler way to re-evaluate the methodology and draw more providers into ACOs, Mostashari and Broome wrote. 

RELATED: CMS proposes 1.84% rate increase for Medicare Advantage plans, other policy changes 

MA rates are easier to understand and are predictable, they said, an improvement over the current ACO approach. In addition, CMS could save money on administering ACOs by taking advantage of the infrastructure already in place for MA. 

"Such an approach would reward quality through increases in the benchmark, reduce administrative burden for CMS and providers, allow consumers to make informed choices between ACOs and Medicare Advantage and provide an opportunity for improvements in both," according to the post. 

RELATED: More than 120 new participants join the Medicare Shared Savings Program for 2018, CMS says 

Medicare beneficiaries who choose to remain in traditional plans would not be hurt as a consequence of this new approach, either, the pair wrote. 

In the early years of the program, results were mixed on whether Medicare ACOs actually led to significant savings, leading a number of providers to drop out. However, in 2016, the Pioneer program earned $68 million in gross savings and the Medicare Shared Savings Program generated $652 million. 

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