With the launch of Pathways to Success, the rules of the Medicare Shared Savings Program (MSSP) are changing for a lot of providers, impelling ACO programs to ready to take on downside risk more quickly. Under the previous MSSP rules, ACOs had up to six years to implement a new program and earn a share of their Medicare savings before taking on any downside risk. Now that transition will happen much faster, meaning ACOs could have to pay back part of any Medicare losses within only two to three years.
There are a few things ACOs need to know as they get started. Providers already know how to deliver high quality care—they have been delivering excellent care for years. The majority of providers also have an eye on their bottom line—no provider will be wasting money if they can help it.
This article describes the top three strategies for ACO providers to successfully continue their push to improve care quality while generating savings for Medicare.
Any ACO can get ready for downside risk in three years. Here’s how to get it done.
1. Take a strong population health approach rooted in robust primary care. Succeeding in value-based payment means transforming the way care is delivered. All members of the care team, including office staff, need to do things differently. A population health approach starts with understanding the health status and needs of all the patients in a practice.
A valuable first step for many ACO practices is getting every patient in for an annual wellness visit (AWV). Unlike a traditional physical exam that focuses on detecting health problems, the AWV includes a comprehensive health interview designed to get a full picture of the patient’s health that will create a prevention and care plan. That care plan usually includes screenings and other preventive services that keep patients healthy and out of the hospital. Starting value-based payment requires getting everyone on board with practice transformation, and it pays off in a short time.
2. Ensure that there are the right people in place to do the work. Primary care transformation is really a team sport, with everyone working at the top of their ability. For many ACO practices, this means having skilled nurses leading the population health charge. Nurses can conduct AWVs, and lead both chronic care management (CCM) and behavioral health integration (BHI). Not only are these activities central to keeping patients healthy and on track, but they are all billable services under Medicare that generate new revenue streams.
Team-based care is not only better for patient care but can relieve stress on physicians. This nurse-led approach frees up physician time for the activities only they can do, like make diagnoses and develop treatment plans.
Many physicians we work with report that having a skilled population health nurse to coordinate between-visit care for high needs patients makes a world of difference in keeping up with preventive care and medication management. With physician moral injury as one of the top concerns for many practices, a team-based approach can go a long way toward heading off burnout.
3. Have enough lives to take risk responsibly. ACOs are not just for large health systems with hundreds of thousands of attributed lives. ACOs can get started with as few as 5,000 lives but sticking with the bare minimum is not optimal.
The numbers don’t lie—having more attributed lives creates more stable and predictable results. Instead of forging ahead with too few attributed lives, smaller providers should consider joining together with other independent providers to scale up and protect themselves against statistical variability that can lead to disappointing results.
Smaller ACOs with fewer than 10,000 lives can experience savings and losses of up to 30%, mostly due to statistical variation. Larger ACOs can avoid this statistical noise that can seriously skew results. The size of an ACO can make the difference between ACO success and failure.
Remember, working together with other independent providers can only help—your biggest enemy is small size.
Pathways to Success, with its faster path to downside risk, can seem daunting. Don’t be scared away from the real benefits of value-based payment. With these three strategies, any provider can succeed in an ACO.
Tim Gronniger, is CEO at Caravan Health, a national leader of accountable care and population health programs for community health systems.