Today’s Accountable Care Organizations (ACOs) continue to earn shared savings under the Medicare Shared Savings Program (MSSP)…but it’s not as easy as it once was. Some ACOs are turning to risk-sharing strategies or improved post-acute care (PAC) clinical standardization to expand their MSSP success. Yet, there’s still more they can do to lower costs and increase quality of care for Medicare beneficiaries – and thus grow their own rewards. Let’s take a brief look at the history of the MSSP, how it has evolved, and how access to real-time PAC patient data can take shared savings to the next level.
Lofty Goals: Better Individual Care and Population Health, Slower Expenditure Growth
Created in 2012, MSSP started small, offering ACOs two different ways to engage. More tracks were added through the years, and then the whole program was revamped at the end of 2018. The final rule, Pathways to Success, has five goals: accountability, competition, engagement, integrity, and quality. It cut the amount of time that ACOs can participate in upside-only financial risk tracks. The rule also added telehealth services, enabled ACOs to incent patients for good health practices, and created detailed ACO performance benchmarks. In addition, it reduced the share of savings for most ACOs. This undoubtedly caused fewer ACOs to take part in Medicare’s flagship program this year, down to 477 versus 517 in 2020.
CMS began offering the Next Generation ACO Model in 2016, under which ACOs take on higher levels of financial risk – and greater opportunities for reward – than those offered under MSSP. The government wants to learn if health outcomes will improve, and expenditures will go down, when ACOs have major financial incentives and greater assistance in driving care management and patient engagement. For the small group of participants, it seems to be working. According to Healthcare Finance, Next Gen ACOs saved Medicare 559 million dollars in 2019, and the average ACO quality score reached 93.7 percent. At the same time, 37 of the 39 participating ACOs earned shared savings. The National Association of ACOs wants CMS to make the Next Gen model permanent, either as a Shared Savings Program option or standalone program.
Shared Savings Advance in Post-Acute Networks
Shared Savings Program ACOs saved a record 1.4 billion dollars in 2019, the most recent year for which CMS has complete data. What’s contributing to this extraordinary performance? Some ACOs are entering into risk-sharing strategies with their post-acute partners.
One new wave is clinically integrated networks, or CINs. CINs enable employed and independent physicians to develop and implement coordinated approaches. They receive financial incentives around shared savings, which in some cases drive other value-based contracts. For pre- and post-acute services, they create preferred provider networks with stakes in both financial and quality outcomes. CIN participants develop and follow common approaches to delivering post-acute care. PAC providers, such as skilled nursing facilities (SNFs) and home health agencies (HHAs), are held accountable to predetermined standards, and volume is driven to the best performers.
ACOs are also growing their shared savings by working with their post-acute providers in all service locations to develop clinical standards by case type. They’re using their specialists to determine standards of care across the network along with national guidelines, and then educating their network on those standards and how to achieve them. From readmissions to length of stay to number of visits, cost goals to quality measures, the PAC providers have clear outcome measures and report them to the network monthly.
Access Current PAC Data to Drive Earned Shared Savings Potential
When it comes to expanding earned shared savings, it’s important for ACOs to focus on their SNF network first; it represents the highest cost segment, and often has the fewest resources and smallest knowledge base. SNFs also have a gold mine of current information – sitting untapped in their EHRs – about the patients who have moved from acute to post-acute care within the ACO. Access to and analysis of that real-time data in the SNF network is exactly what the ACO needs to improve shared savings:
- It enables immediate patient-level management
- It allows faster identification of network and facility trends
- It shows performance by facility, for quicker network adjustments
- It helps coordinate transitions to other network segments (ambulatory, ED, home health)
With fully transparent post-acute patient data – from all EHR fields including narrative notes – the ACO has better control of outcomes. By tracking patient progress through the SNF, the ACO can identify clinical changes more quickly. Patients are then treated promptly in the SNF, and don’t need to return to the hospital. The value of real-time PAC data goes beyond reducing readmissions; it can also manage length of stay, stratify patients according to risk for resource deployment, create and manage standards of care, and improve the ACO support of PAC education and resources. And that’s when the increases in earned shared savings are realized, due to:
- Fewer readmissions
- Shorter lengths of stay
- Smoother care transitions
- Better patient quality and care outcomes
ACOs can also recognize high-performing SNFs with financial incentives via shared savings.
Thanks to the shift towards value-based care, ACOs now cover 32 million Americans. But with half of all post-acute care costs residing in SNFs, ACOs must be smarter about building and leveraging strong PAC networks. If you’re not accessing live, actionable PAC data to improve total cost of care, you’ll be left behind!
Phyllis Wojtusik, RN Executive Vice President, Health System Solutions
With over thirty-five years of health care experience in acute care, ambulatory care, and post-acute care, Phyllis has led the development of a preferred provider SNF network for PENN Medicine Lancaster General Health. In this network she developed and implemented strategies that reduced total cost of care and readmissions while improving quality measures and patient outcomes.