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 ...

Everybody knows: Conferences aren’t just about what you learn but who you meet. Anyone attending the annual National Association of ACOs conference this week in Baltimore should take full advantage of the experts in attendance. This will include executives from leading accountable care organizations, private payers and CMS. NAACOS 2023 will zero in on what you need to know now and who best to learn it from. That includes the industry partners who have helped build incentive-generating infrastructure for the past decade’s most successful ACOs. Analytics first, last and everywhere If there’s any question as to what ACOs need to succeed with alternative payment models, simply look at the topic of NAACOS’ opening session: advanced analytics. There isn’t a single aspect of value-based care that doesn’t happen without analytics: better prevention and primary care; enhanced care coordination; managing risk; benchmarking; and a stronger bottom line. NAACOS sessions will detail these topics wi...

The good news: The Medicare Shared Savings Program (MSSP) has reported a fifth consecutive year of savings while delivering high-quality care for Medicare beneficiaries in accountable care organizations (ACOs). The tricky news: With participation dropping since performance year 2018, ACOs will need places to pivot as success becomes more dependent on risk progression, benchmarking and equity goals. The 2021 MSSP results CMS reported the following highlights from the 2021 MSSP performance year : 99% of participants met the quality targets required for shared savings; 58% earned shared savings; ACOs outperformed non-MSSP providers in metrics related to diabetes, blood pressure, select cancers, fall risk, flu vaccination, tobacco screening and smoking cessation, and screening/remission for depression. ACOs with specific characteristics saved more than their counterparts. This includes ACOs labeled low revenue and those dominated by primary care providers. For example, low-revenue ACOs sa...

Alternative payment programs are critical to payment and care delivery transformation. CMS is introducing new alternative payment models that provide opportunities to deliver better value of care and support healthcare innovation in the years to come. Rising healthcare trends should be taken into consideration when evaluating new APMs. Yet, keeping ahead of which programs offer you the greatest opportunity can be a major challenge. DataGen put together Navigating Alternative Payment Models: A User's Guide , offering insights on the participation categories—and detail on programs within each category—this resource can help you determine the best course for your organization’s future. Download our user's guide to learn about new APMs, implications for providers and data-driven strategies for successful pro gram execution.

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 earn...

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 i...

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. 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 org...