Why a Successful Population Health Strategy Must Include Medicare Advantage

Assessing the Attractiveness of Medicare Advantage Contracts

Medicare Advantage is a private health insurance option for Medicare beneficiaries that offers providers a higher-risk, higher-reward opportunity in comparison to the shared savings program.

Many providers have recognized the necessity of having a Medicare-based population health strategy. However, the shared savings program (MSSP) has not been particularly financially rewarding: only 1 in 4 ACOs earned a bonus in the program's first year.

Discover four reasons why Medicare Advantage contracts are becoming an attractive alternative to MSSP for providers seeking a higher-risk, higher-reward opportunity, and more control over the contract elements.

The population health mandate for Medicare

By 2022, Medicare beneficiaries are expected to compose 58% of provider volumes. CMS is also already holding providers accountable for the cost and quality of care provided to Medicare patients through the Value-Based Purchasing, Readmissions, Meaningful Use, and Hospital-Acquired Conditions programs.

Many organizations see Medicare ACOs as a means of gaining experience with value-based payment and population health management without significant financial risk. However, the Medicare Shared Savings Program (MSSP) hasn't been particularly financially rewarding for most program participants. In the first-year performance results for MSSP ACOs, only about half of the participants generated any savings for Medicare, and of those, only half kept spending low enough to receive any money back through a shared savings payment.

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