- Reconsidering participation in MSSP? Don't overlook antitrust compliance. While anyone would agree that a provider's decision to stay or leave the Medicare Shared Savings Program (MSSP) should be based on a multitude of factors, it's important to not overlook the legal implications of that decision. To learn more about what that might entail, Advisory Board connected with John Steren of Epstein Becker Green who offered some key points for providers to keep in mind moving forward.
- ACOs look to low-risk contracts under revamped MSSP program. Several experienced ACOs have said they don't plan to leave the recently overhauled MSSP, but they may select less risky contracts because of the short deadlines. CMS finalized the revamped MSSP program, called Pathways to Success, in late December 2018, giving ACOs about two months—until February 19—to make their decisions about participation. For instance, Don Calcagno—president of Advocate Physician Partners, a clinically integrated network that's part of Advocate Aurora Health—said Advocate's ACO would likely pick a Level E contract in MSSP's basic track, where the shared-loss rate is 30%, instead of the enhanced track, where the shared-loss rate can be as high as 75%. "Looking at those numbers, that's a big decision, and to be given a short window of time, that's not very tenable," he said.
- Cigna says it's surpassed its value-based care goals. Cigna recently announced that more than 50% of its reimbursements to providers in the organization's top 40 markets are paid through value-based payment models, meaning the organization has "exceeded [the] value-based care goal" it set in 2015. Cigna said it is currently assessing ways to reimburse drug manufacturers through value-based models as well.
From Advisory Board:
- How to develop a community health worker program with positive ROI. Join us on Wednesday, February 27, at 1:00 p.m. ET to learn how to develop a tailored and sustainable community health worker program.
- Examine Medicare's Hospital Inpatient Pay-for-Performance update, FY 2019. Join us on Wednesday, February 27, at 3:00 p.m. ET to learn about important updates to CMS' three inpatient pay-for-performance programs, which place up to 6% of a given hospital's inpatient payments at risk in FY 2019.
- MACRA 201. Join us for 30 minutes on Thursday, February 28, at 3:00 p.m. ET where we’ll explain the complex MIPS policies and their intersection with the APM track.