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July 12, 2018

ACO roundup: CareFirst medical home program saves $1.2B in expected care costs

Daily Briefing
    • MA rankings may undercut plans serving disadvantaged populations, study finds. Medicare Advantage plans serving disproportionately disadvantaged populations would likely perform better on CMS quality rankings if socioeconomic factors were included in risk-adjustment factors, according to a new Health Affairs study. For the study, researchers used CMS data to assess MA plans' care quality, adjusting for factors such as beneficiaries' race, poverty levels, and other socioeconomic measures. The researchers found that when those factors were accounted for, plans serving disproportionately disadvantaged populations performed better on blood pressure, cholesterol, and diabetes control measures.

    • CareFirst medical home program saves $1.2B in expected care costs. Since its launch in 2011, CareFirst BlueCross BlueShield's Patient-Centered Medical Home (PCMH) program has reduced members' projected care costs by nearly $1.2 billion, according to CareFirst. When compared with non-members, members since 2011 have had 21.3% fewer hospital admissions, 22.5% fewer visits to the ED, and 7.8 fewer days in the hospital, CareFirst said.

    • How CMS wants to change MIPS for Medicare Advantage providers. CMS announced it plans to launch a five-year Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, which, if implemented, would "waive Merit-based Incentive Payment System [MIPS] requirements for clinicians who participate sufficiently in certain Medicare Advantage [MA] plans that involve taking on risk." CMS said some MA insurers are creating payment arrangements that "resemble Advanced APMs" under MACRA—but, because those arrangements currently do not qualify as Advanced APMs under the law, clinicians participating in the arrangements still must meet MIPS requirements. CMS Administrator Seema Verma said the proposed demonstration would "test whether MIPS exemptions provided to clinicians under MAQI will increase participation in [MA] plans that are similar to Advanced APMs, and thereby accelerate the transition to a health care system that pays for value and outcomes."

    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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