On August 25, CMS released the 2015 performance results for the more than 400 accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). There is no question the MSSP has been a success for the Centers for Medicare & Medicaid Services (CMS): the number of participating providers and covered beneficiaries continues to grow, quality scores keep improving, and the savings are significant – nearly one-half billion dollars in 2015.
More ACOs also are realizing success in the MSSP. According to CMS, “An increasing proportion of ACOs have generated savings above their minimum savings rate [MSR] each year. For PY15, 31 percent of ACOs (120 of 392) generated savings above their MSR compared to 28 percent (92 of 333) in PY14 and 26 percent (58 of 220) in PY13.”
CMS contends that those organizations with a longer tenure in the MSSP tend to be more successful. CMS reports that 42% of ACOs that began in 2012 generated savings beyond their MSR in 2015 compared to 37% for 2013 starters, 22% for 2014 starters, and 21% for 2015 starters.
Meeting these savings goals not only has contributed to reducing costs of care, but also has spurred significant improvements in quality. Of the organizations who reported on quality measures in 2014 and 2015, CMS notes that 84% improved on quality measures between the two years. Additionally, 92% of ACOs participating in their second or third year saw improvements in overall quality performance scores.
However, time spent in the MSSP is not the only determining factor. Organizations that have the competencies, but only recently signed up for the MSSP also have been successful. Consider the case of two ACOs with top-line results in 2015: Memorial Hermann ACO, which has participated in the program since 2012 and has been the top savings generator each year, and Cleveland Clinic Medicare ACO, which began participation in 2015 and has received significant savings despite its lack of MSSP experience.
Memorial Hermann ACO
Memorial Hermann, the largest not-for-profit hospital system in southwest Texas employing over 24,000 employees with over 5,000 affiliated physicians, has seen tremendous success in the MSSP. Memorial Hermann ACO not only has generated savings in all three years of participation in the MSSP program, but also has earned the greatest savings of all ACOs. The organization’s CEO, Christopher Lloyd, attributes this success to the fact that providing managed care while cutting costs is “not a new conversation” for his organization. Memorial Hermann continues to pursue the following key competencies:
- Developing clinically integrated networks between the hospital and physician networks
- Investing in creating patient-centered medical homes
- Ensuring primary care physician buy-in and understanding
- Identifying cost efficiencies in operational areas
- Investing in methods to track total cost of care
- Hiring technical expertise as needed
Cleveland Clinic ACO
The Cleveland Clinic ACO includes Cleveland Clinic hospitals, employed physicians, and several independent physicians in Northeast Ohio. Cleveland Clinic joined the MSSP in 2015 and was late to the game compared to many of its counterparts who have been participating in the MSSP program since 2012. Despite this, Cleveland Clinic generated significant savings in its first year of participation–approximately $34 million, resulting in earned shared savings of $16.6 million.
While new to MSSP this year, the ACO’s leadership implemented several key initiatives over the past several years to prepare for value-based programs. All of these efforts were considered preparation for entering into the risk-based payment arena. Among the many preparatory steps Cleveland Clinic took, the initiatives below were critical:
- Transforming primary care practices to better manage patient care
- Hiring additional personnel to improve care coordination workflows and reduce heavy administrative burdens on physicians
- Implementing a robust registry for monitoring 33 measures required by the CMS ACO initiatives
- This endeavor took 18 months, defining measures and attributions for the model, developing data governance, developing change management standards and procedures.
- This process required significant expertise in IT, finance, quality, primary care, and analytics.
As outlined in the examples above, the common denominator of success in the MSSP program is not the length of participation, as CMS may suggest, but in fact the dedication of resources to pursue population health management. Commonalities between the two organizations include investments in technical staff, implementation of required cost and quality tracking systems, and primary care integration, all with a focus on creating a continuum of care.
What About Us?
So, what does all of this mean for your organization, particularly if you are on the fence about how and when to join MSSP or pursue other alternative payment models (APMs)?
- Change is coming. CMS intends to have 50% of all Medicare payments flow through APMs by the end of 2018.
- As shown by the MSSP results and case studies, success under APMs takes time, commitment, and infrastructure investments.
- Hope is not a strategy. Even if your organization is not ready for APMs, the time is now to begin developing key competencies.
How Can PYA Help?
PYA can work with you to develop a strategy to move toward risk-based payments and APMs and chart an appropriate and realistic path that will help you achieve success.
- For providers that are just starting to think about transitioning from fee-for-service payments, PYA can provide a variety of services, ranging from organization-wide learning to assistance with establishing fee-for-service care management programs.
- For providers that are building the capacity for population health management, PYA can help with network formation and acceleration, provider compensation redesign, and alternative payment model valuation.
- For providers actively pursuing population health management, PYA can help your organization achieve and sustain success by assisting with intelligent data integration, practice innovation, and risk-based contracting.
For additional information about these and other services that PYA can provide, please check out our Population Health Ascend product line, or contact one of our executives below, (800) 270-9629.
