Ready or not, here come value-based care reforms, says one top Trump administration health official.
On a webinar with the Accountable Care Learning Collaborative (ACLC) on Monday, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma reiterated that it’s “time to take the next step” in Accountable Care Organizations (ACOs).
She argued two-sided risk models lead to better outcomes and lower costs, but 82% of ACOs still haven't made the transition. CMS wants to force those remaining ACOs to switch with a new rule that would limit upside-only models to just two years.
“After 6 years, there’s a lot of experience out there, and we can learn from one another in terms of best practices,” she said—though earlier in the call, she noted two-sided ACOs improve outcomes in part by increasing competition.
Verma's comments came as her agency issued a new report (PDF) evaluating 2016, the first performance year of Next-Generation ACOs (NGACOs), which have a higher level of shared risk (80% to 100%).
The evaluation, conducted by NORC at the University of Chicago, found NGACOs reduced Medicare spending by $62 million after adjusting for shared saving and loss payments. Most of the savings stemmed from reduced hospital and skilled nursing facility utilization. However, annual wellness visits among beneficiaries aligned with NGACO providers increased by almost 12%, reflecting an improvement in care quality.
Of the 18 active NGACOs in 2016, four accounted for more than half (57%) of the reduction in spending. Two of the four existed before the NGACO program commenced—one as a Pioneer ACO and one as a Medicare Shared Savings Program ACO. The other two were new, suggesting new ACOs are just as able to reduce spending as existing ACOs are.
However, the National Association of Accountable Care Organizations (NAACOS) was quick to point out that 15 of the 18 ACOs analyzed had prior experience with the program.
15 of the 18 Next Gens analyzed had prior Medicare ACO experience. Most were in the Pioneer program. They had time before moving to two-sided risk. https://t.co/430lANHa5H— David Pittman (@David_Pittman) August 27, 2018
"The results clearly show that Next Gen ACOs, which include mostly experienced Medicare ACOs, collectively saved Medicare money while maintaining quality," NAACOS CEO Clif Gaus said in a statement. "It’s important to note that these ACOs have traveled a long way under various models in transitioning to value-based payment care, and we are glad to see CMS recognizing their success."
He encouraged CMS to conduct the same "rigorous independent evaluation" of the entire Medicare Shared Savings Program that he said would "demonstrate that MSSP ACOs have saved billions of dollars while significantly improving quality."
Verma argued that waivers “can be very powerful” in convincing providers to take on more risk. Waivers give providers in two-sided models the flexibility to cover telehealth or offer patients incentives.
Among one-sided models, however, “what we see is we’re providing a bunch of waivers" that produce “more expenditures rather than less,” she said.
CMS’ other goals for the ACO program, Verma mentioned, include aligning ACOs with Medicare Advantage and requiring providers to give patients their data.