Advanced Alternative Payment Models. Part I: Understanding the Medicare Shared Savings Program.

Area of Science:

• Healthcare Policy
• Health Economics
• Medical Payment Models

Background:

• The Centers for Medicare & Medicaid Services (CMS) defined Advanced Alternative Payment Models (APMs) in May 2016.
• The Medicare Access and CHIP Reauthorization Act of 2015 introduced the Merit-Based Incentive Payment System (MIPS) starting in 2017.
• Providers are increasingly interested in understanding APMs for future participation and performance management.

Purpose of the Study:

• To review the nature of the Medicare Shared Savings Program (MSSP).
• To explain the risk and benefit-sharing principles within the MSSP.
• To assess the MSSP's suitability as a broad APM for diverse practices.

Main Methods:

• Review of regulatory definitions and legislative changes related to APMs.
• Analysis of the structure and operational principles of the Medicare Shared Savings Program.
• Evaluation of the MSSP's characteristics in the context of Advanced APM qualification.

Main Results:

• The Medicare Shared Savings Program (MSSP) is identified as a fully qualifying Advanced APM.
• The MSSP operates on risk and benefit-sharing principles, allowing providers to share in savings.
• The program's broad nature, lacking specialty-specific elements, makes it accessible for various practices.
• Participation in the MSSP can help providers avoid negative performance adjustments under MIPS.

Conclusions:

• The Medicare Shared Savings Program serves as a significant pathway for providers to engage with Advanced Alternative Payment Models.
• Its inclusive structure offers a viable option for practices and organizations seeking APM participation.
• Understanding the MSSP's risk/benefit framework is crucial for providers navigating new payment models.