In early May, CMS Administrator Seema Verma signaled that the agency intends to push more of its MSSP Track 1 ACOs into taking on downside risk. Now, the industry is awaiting an agency rule under federal review that might force the issue.
A recent study from Avalere found that upside-only ACOs have cost CMS a total of $444 million, while two-sided Track 2 and 3 MSSP ACOs have saved $60 million over five years. Given that in 2010, the Congressional Budget Office projected MSSP ACO savings of $1.7 billion, it shouldn’t surprise Track 1 ACOs that the pressure to show results or migrate up the risk chain is on.
Projections were likely optimistic that ACOs could hit estimates within their initial three-year run. Many have elected to remain in Track 1 status after that initial participation period. As we’ve learned in working with our customers, there’s a lot to put in place to take on risk and manage an ACO, such as including sharing actionable data, risk-stratifying patients, getting clinicians on board and managing care so that you can influence utilization.
But gradually gaining that experience is invaluable. Philips Wellcentive’s 10 MSSP ACO customers generated a total of $18.6 million in value-based revenues in 2016, and supports a health system operating within the Next Generation ACO model, which carries the highest level of risk.
For other systems, the new Track 1+ model, which carries intermediate risk, may be a good fit. Like within other two-sided risk ACOs, participants qualify as an Advanced Alternative Payment Model (AAPM) within MACRA, meaning exemption from MIPS reporting and access to a five percent incentive bonus on billings.