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With CMS Demanding More Accountability in the MSSP, Will It Be 'ACOs Overboard'?
Managed Care (Langhorne, Pa.)
|September 15, 2018
Summary
The Medicare Shared Savings Program (MSSP) Track 1 accountable care organizations (ACOs) must prepare for downside risk. These 169 ACOs, representing 30% of MSSP participants, face contract expirations with the Centers for Medicare & Medicaid Services (CMS).
Area of Science:
- Health Policy
- Healthcare Management
- Value-Based Care
Background:
- The Medicare Shared Savings Program (MSSP) enables Accountable Care Organizations (ACOs) to improve care quality and reduce costs.
- Track 1 ACOs currently operate under an upside risk-only model, limiting their financial accountability.
- A significant portion of MSSP participants, 169 ACOs (30%), are Track 1 ACOs nearing contract end.
Purpose of the Study:
- To highlight the impending transition for Track 1 ACOs from upside-only risk to potential downside risk.
- To emphasize the need for these ACOs to prepare for financial accountability under new contract terms with CMS.
Main Methods:
- Analysis of MSSP participation data.
- Review of ACO contract structures and timelines.
- Identification of ACOs nearing the end of their Track 1 contracts.
Main Results:
- 169 Track 1 ACOs are approaching the end of their current MSSP contracts.
- These ACOs represent 30% of all ACOs within the MSSP.
- The transition necessitates a shift towards models that include downside financial risk.
Conclusions:
- Track 1 ACOs must proactively address the implications of downside risk.
- Strategic planning is crucial for ACOs to adapt to evolving financial accountability requirements.
- CMS's program evolution requires ACOs to prepare for increased financial participation.