![]() 3 McWilliams JM et al., “Medicare spending after 3 years of the Medicare Shared Savings Program,” NEJM, 2018, Volume 379, pp. However, cost savings achieved by the program have been limited: ACOs that entered MSSP during the period from Januto December 31, 2014, were estimated to have reduced cumulative Medicare FFS spending by $704M by 2015 after bonuses were accounted for, net savings to the Medicare program were estimated to be $144M. On the whole, ACOs in the Medicare Shared Savings Program (MSSP) have delivered high-quality care, with an average composite score of 93.4 percent for quality metrics. 2 Health Affairs Blog, “Recent progress in the value journey: Growth of ACOs and value-based payment models in 2018,” blog entry by Muhlestein D et al., August 14, 2018,. Of the roughly 33 million lives covered by an ACO in 2018, more than 50 percent were commercially insured and approximately 10 percent were Medicaid lives. State Medicaid programs as well as private payers (across Commercial, Medicare Advantage, and Medicaid Managed Care) also have adopted ACO-like models with similar goals and payment model structures. Payment models similar to the one adopted by Pioneer ACOs also have been extended to other Medicare ACO programs, with important technical differences in estimates for savings and rules for the distribution of savings or losses as well as some models offering gain sharing without potential for penalties for costs exceeding the benchmark. If total cost of care exceeded the benchmark, ACOs were required to repay the government for a portion of total cost of care above the benchmark. In this incarnation, Medicare set a benchmark for total cost of care per attributed ACO beneficiary: If total cost of care was kept below the benchmark, ACOs were eligible to share in the implied savings, as long as they also met established targets for quality of care. Launched by the Centers for Medicare & Medicaid Services (CMS) Innovation Center in 2012, Pioneer ACO was the first such model design to generate savings for Medicare. The alternative payment model that has gained broadest adoption over the past ten years is the accountable care organization (ACO), in which physicians and/or hospitals assume responsibility for the total cost of care for a population of patients. Introductionīroad consensus has long existed among public- and private-sector leaders in US healthcare that improvements in healthcare affordability will require, among other changes, a shift away from fee-for-service (FFS) payments to alternative payment models that reward quality and efficiency. The views expressed here do not necessarily reflect the views of the Foundation or of MedPAC. 1 Michael Chernew received support for this publication from the Robert Wood Johnson Foundation. Sahni, a partner in McKinsey’s Boston office Rachel Groh, a consultant in the Boston office David Nuzum, a senior partner in the New York office and Michael Chernew, a professor at Harvard Medical School and the Chair of Medicare Payment Advisory Commission (MedPAC). This article is a collaboration by Nikhil R.
0 Comments
Leave a Reply. |