June 14, 2018

ACO roundup: Here's the deal CMS struck with Maryland for its Total Cost of Care Model

Daily Briefing
    • CMS details Maryland's Total Cost of Care Model. CMS this month provided details on its agreement with Maryland to extend and expand the state's all-payer model to outpatient services, marking the first time a state will be fully at risk for Medicare beneficiaries' total cost of care. The Maryland Total Cost of Care Model (TCOC) includes three programs: the Hospital Payment Program, aimed at testing population-based payments for hospitals in the state; the Care Redesign Program, which permits hospitals to incentivize non-hospital providers who work with hospitals and participate in efforts to improve care quality; and the Maryland Primary Care Program, which incentivizes PCPs in the state to provide advanced primary care to patients. The state as part of the model will focus its population health efforts on six areas: asthma, diabetes, hypertension, smoking, substance-use disorder, and obesity. Overall, CMS estimates that the model will save Medicare more than $1 billion between 2019 and 2023.

    • Health groups ask HHS to qualify MA providers for Advanced APM. The National Association of ACOs and 10 other health care organizations this month in a letter to the director of the Center for Medicare and Medicaid Innovation said HHS should allow physicians' Medicare Advantage (MA) participation to count toward their eligibility for MACRA's Advanced Alternative Payment Model (Advanced APM). In the letter, the groups said physicians who work in regions with large MA populations are not able to meet the thresholds for 2018 to have 20% of their Medicare patients or 25% of their Medicare payments billed through an Advanced APM. The groups argued that MA providers are already taking on risk, but currently are unable to quality for the Advanced APM track.

    • Treating patients in low-cost settings saves money. But does it risk lives? Care delivery is shifting away from high-intensity settings and toward low-intensity settings, but "not all such efforts" to move patients toward the lowest-intensity setting "may serve patients well," write Dhruv Khullar and Austin Frakt, who were among the authors of a recent study on the subject, for the New York Times' "The Upshot." According to Khullar and Frakt, the study assessed more than 11 million Medicare hospitalizations and found that nearly all of the patients, regardless of how sick they were, experienced lower mortality rates at the high-cost teaching hospitals—although the benefit varied by patient and condition. While "the shift toward ... lower-cost settings is a worthy goal" considering the "high—and sometimes unjustifiable—cost of some health care settings," the outcomes "in some cases … may not be equal, and it seems we should make sure we're not cutting quality when we're cutting costs," Kullar and Frakt conclude.

    From Advisory Board:

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    • The 2018 MIPS cost category—decoded. Join us on Thursday, August 2, at 3:00 p.m. ET, to learn the metrics included in the 2018 MIPS cost category, how providers' scores will be calculated, and strategies for improving performance.

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    • How to succeed under Medicaid risk. Join us on Tuesday, August 14 at 1:00 p.m. ET for a live panel discussion with population health, health plan, and Medicaid strategy experts from within Advisory Board to learn about key considerations for taking on Medicaid risk and setting up the right infrastructure to manage the population.

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