Lucy Zielinski
Lucy Zielinski

The Centers for Medicare & Medicaid Services (CMS) recently announced the ACOs that will be participating in the Medicare Shared Savings Program (MSSP) as of July 1, 2019, including those participating in the new Pathways to Success structure.

According to the National Association of ACOs (NAACOS), of the 518 MSSP ACOs in 2019:

  • About 40 are new ACOs
  • 152 (29 percent) are participating in two-sided risk tracks
  • 41 are participating in the new Basic Level E and 72 in the new Enhanced Track, and each qualify as Advanced Alternative Payment Models

These numbers represent a smaller number of new ACOs and an overall drop in MSSP participation from the 561 in 2018, but NAACOS interprets this as only a reflection of an off-cycle start date and not an indication that the program and transition to value are slowing down.

The next opportunity to join the MSSP will be in January, when the program returns to its typical schedule of ACOs joining at the start of the calendar year. You can find more information about the application process, which opened July 1, on the CMS website.

The decision about whether to participate in CMS’s new MSSP, Pathways to Success, requires leveraging data and quantitative analysis to project associated risk and returns. Besides understanding the rules of the program, ACO leaders need to understand the cost target, quality rating, and associated risk score they would assume. This allows them to predict financial performance and the funding reserves that would need to be built.

At Lumina Health Partners, we are working with several ACOs across the country to help identify their risk exposure and, more importantly, create a blueprint to help guide the ACOs into shared savings. We created an operationally driven quantitative impact analysis under the new Pathways to Success program. Our assessment approach includes the following components:

  • Leveraging data to assess historical performance against benchmarks
  • Identifying and/or projecting the number of beneficiaries
  • Identifying areas of improvement that will affect the ACO and optimize its performance
  • Calculating potential savings and losses across all MSSP levels
  • Creating cost, quality, and risk levers to predict future impact and risk
  • Creating a financial model for executive leadership to plan for
  • Identifying the starting point for ACOs as they build their operational infrastructure in year 1, and where they need to focus attention in year 2 and beyond
  • Creating recommendations for leveraging current and potential added resources to ensure financial stability and success
  • Creating recommendations regarding evidence-based approaches to bend the cost curve

These outcomes will allow you to make informed decisions that are in the best interest of provider members and to ensure sustainable financial performance under the new rules.

We at Lumina Health Partners would like to learn more about where you are in this journey and share our best-practice recommendations.

For more information about our approach, please see the following articles:

Lucy Zielinski is a managing partner for Lumina Health Partners.