Skip to main content

Three lessons learned from the past year

It’s been a year: a year since the first lockdowns and a year since the landscape of healthcare in the U.S. changed forever. While we’re still evaluating the impacts of the pandemic on healthcare policy, we now have seen enough data to assess the effect of the past year on alternative payments models and how participants are reacting.

It’s been reassuring to see the strength of APMs has broadly held steady, as has the resolve of the participants in those programs, despite the impact of the COVID-19 pandemic. Here’s what we’ve learned this year, along with what (we think) those lessons can teach us about the future.

  1. COVID-19 has not stopped the progress of APMs — but it is delaying it. COVID-19 has extended the period of some programs, like the Comprehensive Care for Joint Replacement and Oncology Care Model, and delayed the start of others, like Kidney Care First and the Radiation Oncology Model. This is, in part, a function of an overwhelmed system. As policymakers and healthcare organizations respond to the pandemic, additional program flexibility has been necessary. This has given providers the chance to evaluate the sustainability of their participation in programs they’re already in, and, while dealing with constrained resources and personnel, deciding if the time is right to enter into new programs.
  2. Most participants are sticking with APMs, despite the pandemic. While the policies stemming from the public health emergency introduced uncertainty into value-based programs, for the most part the pandemic has not scared many participants away. Rather, it is helping them learn what their tolerance for risk is in light of a major situation beyond their control. If anything, APM participants may have been better prepared for the challenge as a result of the value-based transformation they’ve already undertaken. Many participants have approached that transformation seriously and have spent the last couple of years thinking creatively about the ways they can improve care delivery. They have invested a lot of time, energy and money into transformation. Various programs had telehealth waivers in place before the pandemic, so when office visits and care shifted to a virtual format last year, those participants already had some experience to handle the shift. In instances where we saw tremendous declines in participation going into 2021, like in Bundled Payments for Care Improvement Advanced, there were other extenuating changes introduced to the program by CMS that tipped the scales unfavorably toward too much financial risk.
  3. Forecasting risk moving forward could be a challenge. Forecasting performance may not have been easy before 2020, but it was easier to rely on trends from past years to make predictions on cost, improvement and risk. That’s going to be very different moving forward — and not just because 2020 data will be skewed. Moving forward, many patients who deferred care in 2020 for various reasons will re-engage with the healthcare market. Mental and behavioral health challenges are likely to become more important for managing patients’ overall health. That all points toward a high likelihood that the post-COVID era won’t just be picking up where 2019 left off, but will be the start of new trends and require new baselines.

What’s become clear is that while there are many changes, there will, at some point, be a return to the status quo. But that may be a while and it won’t be the status quo of the past. APM participants and any organizations interested in taking on risk or participating in value-based programs in the future should take as many lessons as they can from this past year to become even stronger in the years to come.

Reach out to DataGen to learn more about how to position yourself for success in the new healthcare landscape.

Popular posts from this blog

The Future of Healthcare: Top Trends Providers Need to Address Now

As we emerge from a global pandemic, accountable care organizations must address key new trends now to maintain progress toward value-based care and mitigate financial risk.  Analytics are key to helping ACOs gain a better understanding of trends so they can identify opportunities to drive quality improvement. These trends include: gaps in access to clinical care;  shifts in patient volume; increased demand for virtual care; and  social determinants of health challenges.  To better understand rising trends and actions providers should take, we will reach out to hospital and health system leaders to discuss how recent trends influenced their decision to adopt value-based contracts. Then, during our July 28 webinar, we will release a comprehensive market report on these trends and implications for the future. Preventing gaps in access to clinical care Advanced payment models incentivize ACOs to deliver high-quality care and close gaps in care for patients, thereby earning shared savings

ACOs must act now to get ahead of MSSP changes

Redesigned MSSP program The Medicare Shared Savings Program, one of Medicare’s largest alternative payment models, allows providers and suppliers the opportunity to form an Accountable Care Organization. It was redesigned in 2018, establishing “Pathways to Success” as a way to restructure participation and encourage ACOs to transition to two-sided risk models.  As part of this rule, a BASIC track was established for ACOs to begin participation under an upside-only risk model and to incrementally phase into a two-sided risk model through a glide path. The glide path is composed of Levels A through E, in which there is progressively greater financial risk and potential opportunity for savings.  It is critically important for ACOs to understand how their level of participation in MSSP will change in the coming years. COVID-19 impact on MSSP advancement The COVID-19 public health emergency has disrupted efforts to improve population health and care coordination, and has resulted in a lack

Three more years of CJR: What participating hospitals need to know

On April 29, CMS issued a final rule to extend the Comprehensive Care for Joint Replacement model by an additional three performance years. A number of modifications effective in the extension period aim to improve the model and reflect Medicare policy changes over the last several years. CMS anticipates that CJR will save the Medicare program an additional $217 million over the extension period. The following summarizes the most notable model changes: Three new performance years have been added: PY 6 will include episodes that end between Oct. 1, 2021 and Dec. 31, 2022; PY 7 will include episodes that end between Jan. 1, 2023 and Dec. 31, 2023; and PY 8 will include episodes that end between Jan. 1, 2024 and Dec. 31, 2024. Episode definitions under the model have been expanded to include total hip arthroplasty and total knee arthroplasty procedures performed in the hospital outpatient setting. The episode categories under the extension are site-neutral and are defined as: MS-DRG 470: