Skip to main content

CMS offers Advance Investment Payments to strengthen MSSP equity

 CMS offers Advance Investment Payments to strengthen MSSP equity

Authorized by the Affordable Care Act and established in 2012, the Medicare Shared Savings Program is one of CMS’ first accountable care organization models. For the first time in MSSP’s history, the agency will offer payments upfront to encourage more providers to participate. The new Advance Investment Payments option for MSSP participants will begin with performance year 2024.

Who is eligible for Advance Investment Payments and what do they receive?

Per the CMS AIP guidance, Advance Investment Payments delivers a one-time $250,000 payment upfront to eligible providers who might not otherwise participate in value-based care. These models require substantial infrastructure investments (e.g., technology, staffing, data and analytics partners). CMS will also offer additional quarterly payments per beneficiary per quarter for the first two performance years if the ACO has met MSSP eligibility and compliance requirements.

AIP is only available for ACOs who:

  • have never participated in MSSP;
  • are classified as low-revenue;[1]
  • are inexperienced with Medicare ACO risk-based performance models; and
  • plan to apply to the MSSP BASIC Track[2].

Providers must report, publicly and annually, their planned and actual spending, and repay their AIP from any shared savings earned.

How will AIP change MSSP?

CMS wants to ensure more stakeholders can participate in VBC. The alternative, per DataGen’s Senior Director of Advanced Analytics Alyssa Dahl, would be a “class-divided” system in which providers and patients who are already underrepresented and underserved would be further excluded from an evolving healthcare landscape that seeks to deliver higher-quality, lower-cost and more patient-centered care.

Assessing the next decade of CMS value-based programs, DataGen notes that current payment models “do not reflect the full diversity of beneficiaries represented in Medicare and Medicaid” and that “CMS must drive additional provider participation and minimize selection bias.”  

AIP is the latest example of how CMS is retooling its programs to improve health equity. The ACO REACH program is another. Both programs seek to attract providers in rural and disadvantaged areas who often serve patients with more acute needs — in the areas of traditional healthcare and the social drivers of health.

“It will be interesting to see what the AIP participant profile will look like and how it will affect the MSSP profile overall,” says Dahl.

AIP addresses multiple pain points

AIP offers more funding, operational resources and added staffing to providers, alleviating hesitancy and allowing them to participate in value based models.

Financial capacity can be a make or break for providers. CMS offers MSSP participants, including AIP ACOs, a glide path — a longer timeframe to assume downside risk (financial penalties for failing to meet performance goals).

In addition, AIP money can help providers meet VBC operational challenges: a business case for participation that leaders can confidently support; a system-wide infrastructure built for alternate payments; and the data and analytics needed to create, evaluate and modify population health initiatives.

All of this requires a workforce. With AIP funding, providers can hire more staff to accomplish their MSSP goals.

Get more out of CMS value-based programs

As CMS revises innovation models like MSSP, participants must be prepared to invest their funds differently and more efficiently. A strong data analytics infrastructure helps providers identify the programs that are right for them and take advantage of new opportunities like AIP. Contact DataGen to start preparing.


[1] Per CMS, an ACO “whose total Medicare Parts A and B fee-for-service revenue of its ACO participants is less than 35 percent of the total Medicare Parts A and B fee-for-service expenditures.”

[2] The BASIC Track represents the entry level for assuming risk. BASIC levels A and B involve no financial penalties. Levels C-E include risk and reward.


Comments

Popular posts from this blog

BPCI Advanced – take advantage of the model extension now

The Bundled Payment for Care Improvement (BPCI) Advanced Model is now open for applications until May 31, 2023. This model provides a unique opportunity to acute care hospitals and physician group practices who are looking to: evaluate their bundle performance; rejoin if they have previously dropped out due to being under a convener; or take advantage of the changes to the model. With a small window to sign the participation agreement, you’ll need experts to process data quickly and accurately for evaluation. BPCI Advanced Program Details The Centers for Medicare & Medicaid Services (CMS) announced in October 2022 that this program will extend from January 2024 to December 2025. Data used for evaluation will be taken from the baseline period between October 2018 and September 2022. A participation agreement will be sent out in September 2023 and needs to be signed by October 2023 in order to participate. Those who apply before the May 31 deadline will benefit

BPCI Advanced Model Extension

CMS recently made several major announcements about the Bundled Payments for Care Improvement Advanced Model.  The model, which was due to expire at the end of 2023 (Model Year 6), will be extended for an additional two years through Dec. 31, 2025.  New applications will be accepted in 2023 for the two-year extension. Participants still active in Model Year 6 can continue without reapplying by signing an amended and restated participation agreement for Model Year 7.  New methodological changes will be implemented for Model Year 6, which starts on Jan. 1, 2023. Methodological changes include that: the CMS Discount Factor for medical clinical episodes will be reduced from 3% to 2%;  the Peer Group Trend Factor Adjustment cap for all clinical episodes will be reduced from 10% to 5%; the Major Joint Replacement of the Upper Extremity clinical episode category will become a multi-setting episode category by allowing episodes to be triggered when the procedure is performed in the hospital ou

You’ve been accepted to the Enhancing Oncology Model. Now what?

The Centers for Medicare and Medicaid Services Innovation Center recently announced approved applicants for the new Enhancing Oncology Model. If your facility has been selected by CMS, are you still weighing your options during the current baseline evaluation period?  Two deciding factors may include the program data that CMS provides and whether EOM is enough of an improvement over the prior Oncology Care Model to make your investment worthwhile. Another factor to consider: Will you have the resources in place to conduct a baseline evaluation before EOM’s program start on July 1, 2023? How EOM differs from OCM EOM aims to improve the coordination of oncology care, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment. It includes three major updates: Fewer cancer types. Compared with OCM’s 21, EOM will be limited to seven common cancer types: breast, prostate, lung, small intestine/colorectal, multiple myeloma, lymphoma and chronic le