The Centers for Medicare and Medicaid Services (CMS) has set a new direction for the Medicare Shared Savings Program (MSSP). Referred to as “Pathways to Success,” this program redesign encourages Accountable Care Organizations (ACOs) to transition to performance-based risk more quickly.
Background
Currently, Shared Savings Program ACOs serve more than 10.5 million Medicare fee-for-service (FFS) beneficiaries. ACOs are meant to move CMS’s payment systems away from paying for volume and towards paying for value and outcomes, as ACOs are held accountable for the total cost of care and quality outcomes for the assigned beneficiary patient population they serve. ACOs receive a share of any savings they generate if they meet quality performance and program participation requirements. ACOs participating in a two-sided model must also pay CMS back if spending exceeds the benchmark. ACOs are designed facilitate coordination and cooperation among health care providers to improve the quality of care for Medicare FFS beneficiaries and reduce the rate of growth in expenditures under Medicare Parts A and B.
Prior to the redesign of MSSP, the program included three Tracks. The vast majority of MSSP ACOs entered Track 1, the one-sided, shared savings-only model, under which eligible ACOs receive a share of any savings under their benchmark but are not required to pay back a share of spending over the benchmark. Tracks 2 and 3 are two‑sided models, under which eligible ACOs share in a larger portion of any savings under their benchmark but are required to share losses if spending exceeds the benchmark.
St. Elizabeth Provider Network (SEPN) enters 2019 in its third performance year of MSSP Track 1.
New BASIC and ENHANCED Tracks
(1) BASIC track, which would allow eligible ACOs to begin under a one-sided model and incrementally phase-in higher levels of risk that, at the highest level, would qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program, and
(2) ENHANCED track, based on the program’s existing Track 3, which provides additional tools and flexibility for ACOs that take on the highest level of risk and potential reward. Appendix A summarizes the characteristics of the participation options.
All ACOs participating in the BASIC track’s glide path can reach greater potential reward through relatively higher shared savings rates based on quality performance: up to 40 percent for one-sided models (Levels A and B) and up to 50 percent for all two-sided models (Levels, C, D, and E). The glide path includes 5 levels: a one-sided model available only for the first two years to most eligible ACOs and three levels of progressively higher risk in years 3 through 5 of the agreement period. The glide path concludes with a maximum level of risk that qualifies as an Advanced APM for purposes of the Quality Payment Program.