ACOs

Question 1

ACOs

Key Learnings for ACOs

Answer 1

• Need high quality data analytics
• ACO emphasis on EMR
• Importance of Economics
  
  • ACO needs to generate savings sometime in performance period
• Importance of Planning and Understanding the Opportunity

Question 2

ACOs

Requirements for ACO to be Allowed to Share Savings with CMS

Answer 2

1. Meet Quality Standards
2. Surpass Savings Hurdle Rate

Question 3

ACOs

ACO Quality Standards

Answer 3

31 measures

• Patient/Caregiver Experience
• Care Coordination/Patient safety
• Preventive Health
• At-Risk Population

Question 4

ACOs

Way for Provider Group-Based ACO to Generate Savings

Answer 4

• Care coordination
• Access to integrated records and consistent management
• Develop network of efficient provider
• Focus on quality results in fewer unnecessary services

Question 5

ACOs

CMS Beneficiary Assignment Process

Answer 5

1. Determine ACO Cohorts (group of partners)
2. ACO submits and certifies Participant List (of finalized participating providers)
3. Patients assessed against list of participating professionals to determine if ACO has provided majority of PC services to particular patient

Question 6

ACOs

Uses of ACO’s Certified Participant List

Answer 6

• Recalculate ACO’s historical benchmark
• Determine ACO’s quality sample
• Determine performance year expenditure (shared savings/losses)
• Produce quarterly and annual feedback reports

Question 7

ACOs

Criteria for Beneficiary Assigned to Participating ACO

Answer 7

1. Record of Medicare enrollment
2. At least 1 month of Part A and Part B enrollment
3. No months of Medicare group private enrollment (MA)
4. Assigned to only 1 Medicare shared savings initiative
5. Live in US state
6. Have PC service with physician at ACO
7. Receive largest share of PC services from participating ACO

Question 8

ACOs

Minimum Savings Rate (MSR)

Answer 8

ACO must generate savings of at least MSR * Benchmark to share gains

• Range from 2% (large ACOs) - 4% (small ACOs)

Question 9

ACOs

Initial Benchmark Costs for Performance Year 1

Answer 9

Question 10

ACOs

Updated Benchmark

Answer 10

Question 11

ACOs

Rebased Benchmark

Answer 11

Applies to subsequent agreement periods

• Initial benchmark is adjusted for:
  
  • Risk Scores
  • Trend
  • Savings generated during prior agreement period

Question 12

ACOs

Medicare’s Transition to Performance-Based Risk

Answer 12

Advanced Alternative Payment Models(APMs)

• Involves more than nominal risk of financial loss
• Includes quality measure component
• Has majority of participants using certified EMR technology
• Includes 2-sided ACOs and PCMHs

Question 13

ACOs

ACO Tracks: Shared Savings

Answer 13

• 1 = Up to 50%, Max = 10% of benchmark
• 1+ = 50%, 10%
• 2 = 60%, 15%
• 3 = 75%, 20%

Question 14

ACOs

ACO Tracks: Shared Losses

Answer 14

• 1 = N/A
• 1+ = Limited to 30%, Max = 4% of benchmark
• 2 = 40-60%, 5-10%
• 3 = 40-75%, 15%

Question 15

ACOs

Key Drawbacks of the MSSP Rules for Setting ACO Benchmarks

Answer 15

• Incentive to increase spending in last benchmark year b/c it has highest weight
• Providers that achieve savings in prior period are penalized by lower benchmark in next period
• Incentive to increase use under Medicare

Question 16

ACOs

Strategies for Improving ACO Incentives to Achieve Savings

Answer 16

• Modifying Benchmark Weights
  
  • Equal weights
  • More benchmark years
  • Defer rebasing
• Yardstick Competition
  
  • Benchmark is based on own performance and other provider performance

Question 17

ACOs

Advantages and Disadvantages to Yardstick Competition

Answer 17

• Advantage
  
  • Incentive for efficient providers to enter and remain in program
• Disadvantage
  
  • Inefficient provider = less likely to participate
  • Efficient providers get rewarded for maintaining status quo