CMS PUBLISHES 2020 PERFORMANCE RESULTS FOR MSSP Medicare Shared Savings Program (MSSP) ACOs collectively produced $4.1 billion in gross savings and $1.9 billion after accounting for shared savings payments, according to 2020 performance data CMS published this week. ACOs also hit an average quality score of 97.8 percent, and 60 ACO hit a perfect score of 100, improving care for 10.6 million seniors. These are dramatic improvements over 2019 when ACOs produced $2.6 billion and $1.2 billion in gross and net savings and non-Pathways to Success participants averaged 94.4 percent on their quality scores. In 2020, 513 ACOs participated in MSSP. We will release a more detailed analysis of this week’s data in the coming weeks, and we have already issued a press release on the numbers.
Other notable findings from data include:
ACOs produced $390 in gross savings per beneficiary.
345 out of 513, or 67 percent, of ACOs earned shared savings.
ACOs earned $2.3 million in shared savings payments.
75 percent of one-sided ACOs produced gross savings and 55 percent earned shared savings.
97 percent of two-sided ACOS produced gross savings and 88 percent earned shared savings.
NNAACOS congratulates ACOs on their great work in 2020, especially given challenges facing the pandemic. We encourage members to share 2020 performance results with internal and external audiences, including the press. We have developed a Media Kit to get you started. It’s important to share the results of your hard work and demonstrate the benefits of care coordination and accountable care. Please send your published releases to advocacy@naacos.com, and we’ll publish them on our NAACOS Member News page.
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INDEPENDENT PRESSURE BUILDS ON CONGRESSIONAL DEMOCRATS TO DELIVER On Tuesday after several days of negotiations between moderate Democrats and House Speaker Nancy Pelosi, the House adopted a rule by a vote of 220–212 to allow the $3.5 trillion spending package to proceed. Following concern from moderate Democrats that the infrastructure bill will be held up while the budget—which includes significant social benefits spending—is considered, the rule commits to consideration of the infrastructure bill by September 27. Committees of jurisdiction are now charged with developing their respective budgetary proposals for inclusion in the so-called reconciliation bill, and NAACOS is advocating to those committees covering health care that H.R. 4587, the Value in Health Care Act, should be included in the bill. September promises to bring significant pressure to Congress as it races to meet a number of deadlines, including the expiration of COVID-19 benefits on September 6, a soft deadline for reconciliation package items by September 15, and the expiration of government funding on September 30.
INDEPENDENT ANALYSIS SHOWS $280 MILLION IN SAVINGS FROM VALUE ACT NAACOS recently commissioned an independent analysis by the Moran Company to evaluate the Value in Health Care Act (H.R. 4587), which focuses on supporting ACOs through favorable policy changes to the MSSP as well as advancing value-based payment through updates to the Quality Payment Program (QPP). The analysis of the bill estimates total net savings to the government of $280 million over 10 years if the bill were to be enacted.
Additionally, NAACOS and 11 other leading national healthcare associations recently sent a letter asking Congress to include the bipartisan House bill in the upcoming reconciliation bill, described in the article above. As negotiations in Congress continue in earnest in the coming weeks, it is critical for Congress to hear from ACOs. Please contact your lawmakers today using our Take Action Center to encourage them to support the Value in Health Care Act!
HEALTH AFFAIRS BLOG ON CMMI’S FUTURE Leaders at CMS, including Administrator Chiquita Brooks-LaSure and Center for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler, laid out their vision for driving value-based care programs at CMS over the next decade in a recent Health Affairs Blog. Among their strategic goals is to increase the number of patients in relationships with ACOs. Another is to create a health system with more team-based, care coordination. They also note the need to address the complexity of model overlap and create incentives to entice model participation. These are all goals NAACOS has been pushing for in its advocacy that we are pleased to see CMS articulate.
FINAL PROVIDER LISTS DUE SEPTEMBER 10 Important deadlines are approaching for ACOs and Direct Contracting Entities, including the date by which to drop participants for 2022. Final participant lists for the Global and Professional Direct Contracting Model are due September 10. The deadline for MSSP ACOs to add participants for 2022 was on August 3, but September 10 is the deadline to drop providers. CMS needs final provider lists to run alignment for models to start in January. For DCEs, there are other notable deadlines on September 10, including payment mechanism elections, risk sharing selections, payment mechanism selections, and Primary Care Capitation Payment Percentage selections. See other notable dates for Direct Contracting.
NAACOS WEBINAR WALKS THROUGH 2020 MSSP RECONCILIATION After CMS sent financial and quality results to ACOs for their 2020 performance, many MSSP ACOs were left with questions about how the results were derived. CMS’s formulas and calculations are complex and not always clear. To help ACOs better understand their performance results and program calculations, NAACOS recently held a webinar where data and ACO experts walk through calculations and case studies to explain the results and give tips on how to improve projections for future ACO results. This webinar is now available on-demand.
As ACOs prepare for the opportunity to share their individual results publicly, following the embargo being lifted by CMS, NAACOS recommends ACOs access our Media Toolkit for information on how to best promote your results, educate your community, and issue a press release to highlight your ACO’s achievements.
TIME IS RUNNING OUT TO REGISTER FOR SDOH LEARNING COLLABORATIVE NAACOS and the Institute for Accountable Care (IAC) are hosting a learning collaborative to help ACOs develop effective strategies to address social determinants of health (SDOH) affecting their patient populations. The collaborative includes a half-day in-person kick-off meeting on September 29 followed by six virtual sessions that will cover: needs assessment; resource identification; building a preferred network of community partners; evaluating closed-loop referral platforms; tracking outcomes; establishing payer partnerships; developing the business case for action; and advocacy for regulatory change and reimbursement. There is no cost to participate but interested ACOs must submit an application and space is limited. Additional details and a link to the application are available. Please contact us if you have questions.
NEXT GEN ACOS RECEIVE THEIR RESULTS FOR PY 2020 Next Generation (Next Gen) ACO Model participants recently received their financial and quality results for Performance Year (PY) 2020 from the CMS Innovation Center. These results are embargoed until further notice from the agency, but ACOs may share results internally and with participants. It is anticipated that CMS will make public the program-wide 2020 results in the coming weeks, which is an important opportunity for ACOs and NAACOS to highlight the hard work of ACOs in improving quality and generating savings. We plan to issue a press release on the results and encourage ACOs to publicize positive performance results to demonstrate the value ACOs bring to patients and their communities. Please refer to our Media Toolkit on how to effectively tell your story.
NEXT DIRECT CONTRACTING DISCUSSION SET FOR SEPTEMBER 15 NAACOS has scheduled its next Direct Contracting Learning Discussion for September 15. The event is meant for DCEs that are participating in or planning to participate in the Global and Professional Direct Contracting Model to share feedback, questions, concerns, and points of interest. This collaborative discussion will provide a forum for shared learning. The meeting will take place over Zoom and start at 2:00 pm ET. Advance registration is not required, and the meeting will be recorded for those who can’t participate live. We plan to have experts to discuss compliance, and there should have time to discuss several other topics. If you have issues you’d like to raise, please share them with us.
MSSP PY 2022 CHANGE REQUEST CYCLE: PHASE 1 RFI-2 ISSUED On August 25, CMS issued the second request for information (RFI-2) of Phase 1. ACOs will have until September 10, 2021, at 12:00 pm ET to correct any deficiencies identified by CMS. Additionally, final repayment documentation is due to CMS on September 10, 2021, at 12:00 pm ET. In light of the proposed changes to the required repayment mechanism amounts in the Calendar Year (CY) 2022 Physician Fee Schedule (PFS) Proposed Rule, ACOs have the option to either use the repayment mechanism amount provided on August 25, 2021, to finalize their repayment documentation, or hold on finalizing their repayment mechanism arrangement until further notice from CMS, pending the issuance of the CY 2022 PFS Final Rule. ACOs that select the latter option may have a limited opportunity to resolve any deficiencies and have the repayment mechanism approved in time for the start of PY 2022. Those ACOs are encouraged to submit draft repayment mechanism documentation to CMS for review by the September 10 deadline. For more information, a CMS application toolkit is available with helpful guidance and resources. Additional information about the application timeline is also available. As a reminder, application dates are subject to change.
UPCOMING WEBINAR: PARTNERING WITH GEDS More than 200 U.S. emergency departments are now certified as Geriatric Emergency Departments (GEDs) that strive to identify care gaps and unaddressed health needs that could result in repeated readmissions and to effectively transition patients to appropriate outpatient settings when inpatient services are not indicated. Partnerships between ACOs and GEDs could reduce preventable acute care services and improve outcomes for elderly patients with complex needs. On September 14 at 2:00 pm ET, NAACOS will hold a webinar to provide an in-depth look at the capabilities and structure of GEDs and explore opportunities for partnerships with ACOs.
CMMI TO MAKE MORE NEXT GEN DATA AVAILABLE Following years of NAACOS advocacy, CMMI announced it will provide data on the Next Gen ACO Model that will allow researchers to conduct more detailed analysis on the program’s first three years. This data, contained in what’s called Research Identifiable Files, includes enrollment data for Next Gen-assigned beneficiaries and participating providers and will allow independent analysis of the program to better show its benefits. This includes counterfactual studies of Next Gen’s savings. NAACOS is very pleased to see CMS release this data after having advocated that CMS do so.
CAHPS FOR MIPS VENDOR AUTHORIZATION CLOSES SEPTEMBER 15 On August 10, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for Merit-Based Incentive Payment System (MIPS) vendor authorization tool opened. As a reminder, beginning in 2021 ACOs will be evaluated on the CAHPS for MIPS Survey as part of MSSP quality evaluations. CMS notes each ACO’s Primary Authorized to Sign (ATS) contact should have received a link to access the online Vendor Authorization Tool. This email was sent by aco-cahps@rand.org. ACOs must authorize a vendor using the Vendor Authorization Tool by Wednesday, September 15, 2021. Contact SharedSavingsProgram@cms.hhs.gov with any questions.
CMS TO EXTEND 2020 MIPS TARGETED REVIEWS Due to a widespread CMS calculation error, CMS will be updating MIPS performance feedback and final scores for 2020 performance, which will dictate 2022 payment adjustments. As a result, CMS plans to extend the 2020 MIPS targeted review deadline. Due to the wide-ranging extreme and uncontrollable circumstances (EUC) policy applied to all MIPS eligible clinicians for PY 2020 due to COVID-19, bonuses in the program for 2020 performance distributed in the 2022 payment year are expected to be very minimal. Check your MIPS score by logging into the QPP website.
MSSP Q2 REPORT PACKAGES DELIVERED TO ACOS CMS recently delivered MSSP PY Quarter 2 (Q2) report packages to ACOs, which include files such as the Assignment List Report (ALR), Assignment Summary Report (ASR), Aggregate Expenditure/Utilization Report (EXPU), Beneficiary Expenditure Utilization Report (BEUR), and Non-Claims Based Payment File (NCBP). ACOs can pose questions to other NAACOS members through the NAACOS listserv.
NAACOS WELCOMES NEW VP OF EDUCATION, MELODY DANKO-HOLSOMBACK NAACOS is pleased to announce Melody Danko-Holsomback as its Vice President of Education. In this newly created position, Melody will lead NAACOS’ education on value-based care and support members’ educational needs. Melody was formerly the Chief Administrative Officer and Director of Operations and IT for Keystone Accountable Care Organization. She has more than 27 years of practical experience in nursing and has performed nursing roles in community practice, inpatient, and post-acute care settings. Melody also currently works as a skilled nursing facility provider for Geisinger Clinic.
