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The Centers for Medicare & Medicaid Services (CMS) just released the Medicare Shared Savings Program (MSSP) application form and timeline for accountable care organizations (ACOs) looking to participate or renew participation in January 2021.
Key dates are:
With looming deadlines afoot for a program that could mean future success or duress for health systems, there are a few important things leaders need to know.
MSSP accountable care organizations (ACOs) are reducing Medicare spending and increasing quality. In fact, participants achieved nearly $740 million in savings in 2018. Moreover, the National Association of ACOs has reported that MSSP ACOs saved a gross $1.8 billion, nearly double the amount CMS reported in performance years 2013 through 2015.
It is evident that MSSP ACOs are making real progress. The benefit for health systems that participate is that they have the ability to own the design and financial success of the new care delivery and payment models that are required for this program. In essence, MSSP ACOs have control of the premium dollar because they own the payment model.
However, this means that health systems that choose not to participate in the program but operate in markets where competitors, payers and other physician-organizing entities are participating could be missing an opportunity for sharing in the savings generated for their very own patient populations. Getting to market ahead of these organizations is a strategic imperative for health systems. Deciding not to participate places the system’s hospitals at risk, as they will be viewed as cost centers by other ACOs and a means to generate savings via reduced utilization.
The Pathways to Success program has tacked on to similar value-based payment programs, such as the Bundled Payments for Care Improvement Advanced model, to give everyone in healthcare a simple message. This administration will continue to shift risk from government payers to private entities, meaning everyone has a decision to make – and fast.
Savvy businesses want to be organizers of alternative payment models because they see the opportunity for profitability and want to control the premium dollar. But health systems are best positioned to succeed in owning these models because they can control the integration of care delivery processes better than a third party.
Hospitals and health systems have been leaders in building and implementing innovative ways to improve health and promote value-added care, including enhancing quality and reducing the total cost of care. Successful ACOs and alternative payment models, such as bundled payments, are a powerful means to increase revenue, manage costs and get better reimbursement for these advancements.
As the broader value-based payment landscape rapidly evolves, it is high time for healthcare providers to participate in these models, not only for financial success, but also to stay competitively viable by building essential capabilities for the future.
The MSSP also:
Whether or not the MSSP is the right fit, there are options for health systems that want to succeed in the future and Premier® can help.
To learn more about the Pathways to Success program or alternative approaches for success: