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CMS also reported that ACOs in the Medicare Shared Savings Program saved more under new Pathway to Success tracks and if they assumed downside risk.

By Jacqueline LaPointe

September 15, 2020 – Medicare Shared Savings Program (MSSP) generated $1.19 billion in total net savings to Medicare in 2019, representing the third consecutive year for net program savings and the largest annual savings for the program to date, CMS Administrator Seema Verma recently reported.

In a Health Affairs blog post yesterday, Administrator Verma shared the results from the MSSP’s 2019 performance year. It was the first year accountable care organizations (ACOs) in the program could participate under new tracks through Pathways to Success.

In 2019, MSSP ACOs had the option of joining a new Pathways to Success track starting in July or continuing in one of the existing participation or “legacy” tracks. In total, 541 ACOs participated in the program during the performance year.

But ACOs in the Pathways to Success tracks performed better than their counterparts in legacy tracks, according to Verma.

ACOs under Pathways to Success options generated net per-beneficiary savings of $169 per beneficiary versus $106 per beneficiary for legacy track ACOs.

Even new entrants to the MSSP that joined through a Pathways to Success track saved (net per-beneficiary savings of $150) despite the long-standing record of first-time ACOs not achieving savings in their first performance year, Verma highlighted.

Rural ACOs, which have also had a rocky past with program savings, improved their performance under Pathways to Success, she reported.

Urban ACOs and rural ACOs participating in the new tracks generated $170 net per-beneficiary savings and $158 net per-beneficiary savings, respectively, while among all the MSSP ACOs in 2019, urban ACOs generated $125 net per-beneficiary savings and rural ACOs generated $64 net per-beneficiary savings.

Additionally, Verma reported that ACOs that took on downside financial risk under both participation options in 2019 saved more per beneficiary than those that remained in upside-only tracks ($152 per beneficiary compared to $107 per beneficiary).

Physician-led ACOs also continued to outperform their hospital-led counterparts as demonstrated by low-revenue ACOs producing net per-beneficiary savings of $201 per beneficiary compared to $80 per beneficiary among high-revenue ACOs.

Finally, nearly all ACOs in 2019 met the quality performance standard, Verma reported. About 92 percent of eligible ACOS also earned quality improvement reward points for the year.

The early results from the 2019 MSSP performance period show that Pathways to Success is living up to its moniker, according to Verma.

“When the redesign of the program was first announced, some stakeholders expressed concern that new ACOs might be reluctant to participate in these new participation options, given the changes in the financial benchmarks and the speed at which ACOs would need to take on downside risk. However, these early results suggest that greater financial accountability under the Pathways to Success policies has produced the stronger incentives for ACOs to deliver better coordinated and more efficient care for Medicare beneficiaries,” she wrote in the blog post.

The redesigned program also better supports rural ACOs and encourages more rural providers to implement value-based care, the post continued.

But the National Association of ACOs (NAACOS) – one of the stakeholders that has expressed concerns about the Pathways to Success redesign – is still worried about MSSP participation.

Only 5 percent of eligible ACOs elected to enter the redesigned program early, with the remaining ACOs choosing to stay in one of the legacy MSSP tracks, the industry group reported.

“Unfortunately, ‘Pathways to Success’ has already shown to diminish ACO participation,” Clif Gaus, ScD, president and CEO of NAACOS, said in a statement shortly following the results.

Gaus’ group urged Congress to consider new legislation that would improve the Medicare ACO program despite Verma’s report on MSSP performance in 2019.

The NAACOS-backed legislation titled the Value in Health Care Act was introduced this July to boost participation in the MSSP by increasing shared savings rates for ACOs in upside-only risk tracks to at least 50 percent for those in the Levels A and B of the Pathway to Success’ BASIC track and 55 percent for those in Levels C and D.

The bill would also extend the 5 percent incentive payment for participation in certain alternative payment models under MACRA and reduce thresholds for participation in the models.

Other groups like Premier Inc. also used the Verma’s blog post to push other legislation like the Rural ACO Improvement Act (2648) and Accountable Care in Rural America Act (H.R. 5212), which would remove an ACO’s attributed population from the regional benchmark calculation.

The Value in Health Care Act though could not come at a better time, Gaus emphasized.

“These results clearly show that ACOs are helping improve our health system at a time when it’s needed more than ever,” he stated. “When we emerge from the ongoing pandemic, we’ll need alternatives to fragmented fee-for-service and better cost-control strategies, which ACOs provide. There should be no debate that we need to foster the growth of more ACOs so their benefits are delivered to more seniors.”

COVID-19 has the potential to derail ACO progress, according to providers.

“As with everyone in the industry, we’re concerned about the impact of COVID-19 on our value-based care programs,” Shawn Morris, CEO of Privia Health, told RevCycleIntelligence. “Many patients postponed wellness visits and health screenings while following stay-at-home orders and maintaining social distancing – thus limiting a physician’s ability to address and capture their patient’s medical conditions. This can have a negative impact on the ACO’s ability to improve patient outcomes and achieve shared savings.

Privia Health is maintaining its commitment to participating in the MSSP with its four ACOs though. In 2019, the ACOs earned shared savings of $57 million, Morris reported.

“Our providers use technology, team-based care, and unique wellness programs to keep people healthy, prevent disease, and improve care coordination both in and outside of the doctor’s office – including our virtual visits platform, chronic care management programs, remote patient monitoring and digital communications tools (patient app, texting, provider messaging, online scheduling, etc.),” Morris said.

“We appreciate the expanded telehealth for Medicare beneficiaries, and believe this played a crucial role in our provider’s ability to stay connected to patients throughout the year,” Morris continued. “Telehealth and virtual visits are now woven throughout our healthcare delivery system. This modern face-to-face doctor’s appointment – embraced by patients of all ages – must continue as a means to provide care both related, and unrelated, to global pandemics.”

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