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As the healthcare landscape evolves, the importance of adopting value-based care strategies in the Traditional Medicare program becomes increasingly evident. This podcast episode is going to provide you with invaluable perspectives on navigating the complexities of value-based care and making informed decisions for the future success of your organization with the MSSP and ACO REACH programs.
Joining us for this episode is Joe Satorius – an expert on advanced alternative payment models in the Medicare program. Joe serves as Senior Vice President, Risk-Based Medicare and ACO Programs for Lumeris. In this capacity, he oversees comprehensive performance and operational functions related to population health initiatives, provider partnerships, and ACO REACH programs. Joe brings deep expertise in alternative payment models which reward health care providers for delivering high-quality and cost-efficient care and is a sought-after speaker and authority on CMMI programs.
- Read Transcript Below:
Welcome to Episode 2 of Enabling Health Value!
As the healthcare landscape evolves, the importance of adopting value-based care strategies in the Traditional Medicare program becomes increasingly evident. This podcast episode is going to provide you with invaluable perspectives on navigating the complexities of value-based care and making informed decisions for the future success of your organization with the MSSP and ACO REACH programs.
Joining us for this episode is Joe Satorius – an expert on advanced alternative payment models in the Medicare program.
Joe serves as Senior Vice President, Operations & Enterprise Strategic Initiatives for Lumeris. In this capacity, he oversees comprehensive performance and operational functions related to population health initiatives, provider partnerships, and ACO REACH programs. Joe brings deep expertise in alternative payment models which reward health care providers for delivering high-quality and cost-efficient care and is a sought-after speaker and authority on CMMI programs.
Spoiler Alert… be on the lookout for a new Enabling Health Value Podcast later this month with a very special guest… Micky Tripathi, the national coordinator for health information technology at HHS and co-chair of the task force responsible for developing a strategic plan on the responsible use of AI in healthcare, as mandated by President Biden in an executive order last year. This will be a conversation you will not want to miss!
But before then, let’s now hear from Joe Satorius as he joins us this week on the Enabling Health Value podcast!
- VBC as a Strategic Imperative: You and I recently wrote a Lumeris whitepaper together where we make the case for why committing to a value transformation strategy within the MSSP or ACO REACH is so critical for the future of health systems and physician practices. These programs serve as economic models for care delivery innovation, with payment structures that support the reorganization of care delivery towards patient-centered care. Realignment of financial incentives are so critical for the future of healthcare in our country, but it is also equally critical for the survivability of healthcare organizations in the short-term. For the first time ever, there is a collective recognition in the provider community that value-based care adoption is imperative to ensure strategic positioning and financial security. For many healthcare executives, this is a sea change in their perspective where VBC is a “nice to have” component of your revenue portfolio. Instead, it is a “need to have” since two-sided Medicare risk is the only way to amplify upside opportunities in both clinical and financial transformation. Sitting on the sideline is no longer an option for value-based care…you are harming the future of your business by not entering the arena. As we start our conversation today, can you describe this critical juncture facing health systems and physician practices? And how does joining MSSP or ACO REACH present a viable path forward to ensure long-term solvency through care delivery transformation?
Absolutely, this is a pivotal moment for health systems and physician practices alike. The recognition that value-based care adoption is not just desirable, but imperative for strategic positioning and financial security marks a significant shift in perspective within the provider community.
At this critical juncture, health systems and physician practices are facing the challenge of realigning financial incentives to support the transformation of care delivery towards patient-centered models. The traditional fee-for-service model is no longer sustainable in meeting the evolving needs of patients and the healthcare landscape.
The landscape of the healthcare industry is changing at a hyper-accelerated rate. It is hard enough for healthcare executives to make sense of industry signals as daily consumers of intelligence, but I also think about the role of governing boards within health systems. The role of a board member is especially challenged at this moment because their fiduciary responsibility to govern a viable healthcare business is completely different than it has been historically. They are faced with learning curve challenges and an ever-collapsing role for strategic planning when it comes to ensuring sustainable care delivery systems for seniors in the long-term.
The pace of industry disruption is unprecedented, and the gestalt of the new value paradigm is difficult to understand for everyone, including the patients we serve and the clinicians that that are on the frontline delivering care. Conventional thinking anchored to an incumbent fee-for-service business model will not bring about organizational stability. Healthcare leaders and board members need to become educated in the tenets of value-based care in the Medicare program to understand why adopting financial risk in a health system’s revenue portfolio will be necessary to ensure population health and equitable health outcomes.
At Lumeris, we bring together economic models and structures that align with the reorganization of care delivery to take on two-sided risk contracts. Readiness to take downside risk is important because two-sided risk contracts are a strategic lever for amplifying upside revenue potential. And I would argue, most importantly, that risk-based payment models in the Medicare program are the only way to reimagine care delivery so that it is truly accountable in ensuring high quality, cost effective, equitable care for the patients we serve.
Joining programs like the MSSP or ACO REACH presents a viable path forward for organizations seeking to ensure long-term solvency through care delivery transformation. These programs offer economic models that incentivize innovation and support the reorganization of care delivery towards patient-centered care. By committing to value transformation within these frameworks, organizations can amplify both clinical and financial transformation opportunities, positioning themselves for success in the evolving healthcare landscape.
Furthermore, participating in value-based care programs enables organizations to mitigate the risks associated with fee-for-service reimbursement while capitalizing on the benefits of proactive, preventive care. This shift towards value-based care is not only essential for the future of healthcare in our country but also critical for the survivability and sustainability of healthcare organizations in the short-term.
MSSP or ACO REACH represents a strategic imperative for health systems and physician practices, offering a viable path forward to ensure long-term solvency and success through care delivery transformation. It is critical that they are considered to be of paramount importance in strategic planning, especially with the aging of our population and the need to more effectively care for patients with chronic disease. In my mind, as a healthcare leader, this is the challenge that we must confront head-on to adapt to the changing landscape of healthcare delivery. Value-based care models that prioritize patient outcomes and financial sustainability are the way forward. And the Medicare program – through the MSSP and ACO REACH presents us with a golden opportunity to not only safeguard the future of our organizations but also fulfill our commitment to providing high-quality, equitable care for the patients we serve.
- Adoption Readiness: Transformation success is contingent on readiness for risk-based payment. Delivering care that is both high touch and high tech – utilizing the full enablement potential of holistic, patient-centered, relationship-based models of care with technology, analytics, and AI – requires experiential knowledge, strategic planning, and a culture of innovation within healthcare organizations. In over a decade of ACO Performance Results from the Medicare program, it has been shown that more experienced ACOs achieve higher levels of savings and mitigate their exposure to the downside. The MSSP appears to be a great entry point into value-based care, whereas ACO REACH presents the best opportunity for more experienced providers who have developed a maturity model around risk. If leaders select a program with downside risk that their network isn’t fully equipped to handle, they risk having to foot a large bill to CMS during reconciliation the following year. Conversely, if they over-cautiously select a program that offers too little upside opportunity for a system already on the value-based care transformation curve, they risk forfeiting significant earned savings to CMS and risk not having enough savings distribution for their network. An overly conservative approach when it comes to financial risk aversion not only limits upside rewards; it poses an unintended consequence of losing aligned providers and beneficiaries to other networks, physician aggregators, and vertically integrated payers that provide access to total cost of care models with the population health enablement capabilities to succeed. How should healthcare leaders effectively balance the pragmatic strategy of gradually adopting risk-based payment with the imperative of accelerating value-based readiness by embracing the necessary level of risk to acquire expertise, maturity, and capability? What should executives and board members be thinking about right now about as they evaluate their suitability for either MSSP or REACH in planning their Medicare value-based strategy?
Healthcare leaders face a crucial balancing act between gradually adopting risk-based payment strategies and accelerating value-based readiness to ensure organizational success and sustainability. This requires careful consideration of several key factors.
First off, leaders must assess their organization’s readiness for risk-based payment. This involves evaluating their level of expertise, maturity, and competency in value-based care practices. Organizations should conduct thorough assessments of their infrastructure, data analytics capabilities, and care delivery models to identify areas for improvement and development.
Through the promulgation of health policy and the implementation of new alternative payment models at CMS and CMMI, we have seen a landscape created for experimentation in value-based care, yet the seismic shift needed to facilitate long-term and sustainable improvements will only occur if healthcare organizations have an appropriate level of competency and execution capability to succeed in this new paradigm. In value-based care, we are talking about completing transforming the way our systems operate and deliver care, requiring our workforce to align on the necessary inputs to ensure a more holistic, relation-based, patient-centered, data-driven way of delivering care. This requires us to go upstream to understand the root causes of disease and remove the necessary barriers to ensure improved outcomes.
I believe the key enabler for the future of our industry is workforce readiness to deliver on the promise of high value, high quality care that delivers equitable outcomes for all. However, you can’t go this alone. To achieve value-based readiness in the culture of your organization, you need access to capital, infrastructure, technology, and expertise that inform new systems of care.
At Lumeris, we partner with healthcare providers to enable value-based care success in for all populations via risk-sharing and total-cost-of-care models. We work every day to empower physicians, care team members, and health systems to fulfill the promise of value-based care by developing and executing strategy, operationalizing clinical programs to improve population health and reduce costs of care leveraging our proprietary technology and deep expertise. We seek to partner with healthcare organizations to accelerate value-based care adoption across their entire enterprise. In doing so, we align with our partners not just operationally, but also financially. We develop long-term relationships with providers through in a financially aligned model that ensures all parties have skin in the game.
We define value-based care as creating a system of care every doctor wants for their own family. We believe value-based care transformation best occurs when healthcare providers and organizations adopt evidence-based models for driving clinical care improvement to lower total cost of care while delivering superior clinical outcomes across all populations and communities our partners serve. We accomplish this through the co-creation of a system of care with our health system and provider partners that is enabled by AI-powered technology, people, and processes to data meaningful action upon the data insights we are able to surface at the point of care.
When we are successful, the culture of an organization changes towards patient-centricity and accountable care. And trust me…this is hard work. It doesn’t happen overnight. You need a strategic commitment from the highest levels of the organization.
In your question you asked about incremental pacing versus accelerated pacing in value-based care adoption. I hear ACOs across the country asking the same question all the time…how much of their business needs to move to risk for them to have passed the ‘tipping point’ for value?” Does a true shift in the business model occur at a “financial tipping point” where a large majority, upwards of 70-percent of a system’s business is at risk and the economic model of the system is based on managing the total cost of care? If so, how do you operate in that “payment straddle” where the FFS curve and the Value curve intersect? There is no easy answer to this, but the overall key for strategic planning is you have to minimize time in the straddle between curves in the way that makes the most sense within your local market. It is a different answer when you’re a large health system than if you’re a regional or suburban single-facility hospital, single hospital, or whether you’re a multispecialty group practice or a single specialty group practice.
This is the ultimate CFO’s dilemma–which is the recognition that, as you start shifting a portion of your fee-for-service revenue into contracts that are at risk, the effect of those risk contracts, especially if they’re linked to optimizing outpatient care at the expense of hospitalizations, you’re going to end up with an increase in margin per patient under your at-risk contracts, but your top line revenue as a system is actually going to decrease and the margin that you make on that top line revenue–meaning an inpatient stay–is going to disappear. And until you get to a certain critical point of risk contracts with associated margin per patient that can offset the decrease in the margin that you’re generating from the lost incremental hospitalization, you are at a deficit as an organization. Needless to say, your value-based care strategy has to be really, really, clear financially. Ultimately, the tipping point is really a function of the shift in how your margin exists in your system and how you can allocate that on a fixed asset base. Which, for most systems is high, and also is, in many cases, ladled with debt service that you can’t just ignore. This is where an enabling partner, like Lumeris, can come in and share in the financial risk.
With regard to this specific decision point of joining MSSP or ACO REACH, leaders must weigh the benefits and risks associated with each program. While MSSP may serve as an entry point for organizations new to value-based care, ACO REACH offers opportunities for more experienced providers to further develop their maturity model around risk. Executives and board members should carefully evaluate the potential upside and downside of each program in relation to their organization’s capabilities and strategic goals.
Once a healthcare organization is on the path to value-based care and participating in these value-based Medicare programs, I would also emphasize how important it is for healthcare leaders to foster a culture of innovation and continuous learning within their organizations. This includes investing in training and development programs for staff, fostering collaboration across interdisciplinary teams, and encouraging a mindset of experimentation and adaptation to drive value-based care initiatives forward.
Ultimately, executives and board members should approach their evaluation of MSSP or ACO REACH with a forward-thinking mindset, considering not only the immediate financial implications but also the long-term strategic impact on their organization’s ability to deliver high-quality, patient-centered care. By effectively balancing the pragmatic adoption of risk-based payment with a commitment to accelerating value-based readiness, healthcare leaders can position their organizations for success in the evolving healthcare landscape.
- TIN/NPI-Level Segmentation: While many networks are looking to test out their value-based competencies and need a risk corridor buffer, market disruptors and CINs with the resources and experience to successfully manage total cost of care are looking to capitalize on the significant investments they’ve made into population health to increase their access and capture of first dollar risk. Primary care centric organizations are looking to partner with their PCPs in total cost of care models, while large multispecialty groups and academic medical centers are seeking to optimize incentives for their specialists. If health systems and CINs participating in value-based care choose to move their providers through the risk continuum uniformly, there will certainly be missed opportunities and greater potential for losses. With NPI level participation available in ACO REACH, it seems like there is an opportunity to consider a bifurcation strategy where specific providers can be positioned to succeed in accordance with their value-based readiness. Can you explain how the MSSP and ACO REACH options can potentially be combined depending on organizational priorities and existing network makeup and infrastructure rather than the one-size-fits-all approach to contracting that is most common today?
Certainly. The MSSP and ACO REACH options offer distinct opportunities for organizations participating in value-based care, and combining these options can provide a tailored approach to meet specific organizational priorities and network makeup.
CMS continues is on a quest to shift all traditional Medicare to accountable care payment arrangements by 2030, and it important to gain experience in one or both of these programs as soon as possible. And this especially true in this moment as CMS is seeking to make participation in these programs more attractive and attainable for providers in many diverse markets. We talked earlier about how success requires active physician leadership, patient-focused care teams, analytic rigor and structures that assure aligned incentives. If you are able to clear that hurdle in your strategic commitment, the MSSP and ACO REACH truly are blue sky opportunities!
So, allow me to speak a little bit about each program. And it is important to note, for the purpose of today’s conversation, we are focusing just on Traditional Medicare. However, I would be remiss if I didn’t also mention how important Medicare Advantage is to an organizational strategy for managing senior lives. MA is on the leading edge of consumer-centric design in Medicare, with ACO REACH adopting many of the same operating levers. MA is a key value driver because it relies on a capitation system that allows for a variety of benefits, greater efficiency and patient satisfaction, and a better emphasis on social determinants of health. MA plans are a great area of really seem to be an area of consumer-centric innovation in healthcare. For the purpose of today’s webinar topic, I’ll focus my attention to MSSP and ACO REACH.
The Medicare Shared Savings Program (MSSP) is CMS’ flagship ACO program. It provides a solid foundation for organizations new to value-based care. Its various tracks offer flexibility in risk levels, allowing organizations to gradually transition towards more advanced risk arrangements as they build their capabilities and experience. Capitalizing on an available window to pursue upside-only risk is especially crucial for new entrants into Medicare risk.
On the other hand, ACO REACH offers a unique opportunity for organizations with more experience and readiness to take on increased risk. Its focus on total cost of care models and NPI level participation enables targeted strategies that align with specific provider specialties and patient populations.
By combining MSSP and ACO REACH options, organizations can leverage the strengths of each program to create a comprehensive value-based care strategy. For example, primary care-centric organizations may initially participate in MSSP to establish a solid foundation in value-based care, while concurrently exploring ACO REACH opportunities to optimize incentives for specialists within their network.
Furthermore, this approach allows organizations to align their contracting strategies with their existing network makeup and infrastructure. Rather than adhering to a one-size-fits-all approach, organizations can tailor their participation in MSSP and ACO REACH based on the unique needs and capabilities of their providers and patient populations.
In summary, I would just say that it is highly advantageous to combine MSSP and ACO REACH options since, together, they offer organizations a flexible and customized approach to value-based care participation. By strategically leveraging the strengths of each program, organizations can maximize opportunities for success and better position themselves for long-term sustainability in the evolving healthcare landscape.
- Advanced APM Bonus: Joe, I’d love to get your perspective on how the advanced APM bonus, or lack thereof, factors into the decision-making to accept financial risk. Since MACRA became law in 2015, there have been two tracks to follow in the Quality Payment Program: The Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models. A 5-percent incentive was created to help providers move into payment models with downside risk, such as ACOs, that encourage higher quality, more efficient, and more cost-effective care. Those in advanced APMs are exempt from MIPS and earned an annual 5% bonus from 2019 through 2024 and will earn a 3.5 payment in 2025. Further reduction will certainly undermine provider migration to APMs, as evidenced by the questions we’ve received from many in our audience. Understandably, you don’t know the future; however, you’ve spent considerable time thinking about the strategic implications of continued provision of the Advanced APM Bonus versus the cliff effect we face should the bonus decrease to 0.5% or expire altogether. How should the uncertainty of the Advanced APM Bonus factor into the consideration of risk-based payment in the Medicare program? Is it prudent to quantify the potential financial loss of a reduced bonus, when doing so might overshadow the importance of embracing a calculated level of risk sooner than later? What guidance can you provide in formulating a VBC adoption strategy that balances short-term gains with building a foundation for long-term success?
The uncertainty surrounding the Advanced APM Bonus is indeed a critical factor in the decision-making process for accepting financial risk in the Medicare program. Providers must carefully weigh the potential impact of changes to the bonus on their overall financial outlook and strategic goals.
While it’s natural to want to quantify the potential financial loss associated with a reduced bonus, it’s equally important to consider the broader strategic implications of embracing risk-based payment models. A calculated level of risk-taking can position providers for long-term success by driving quality improvement, care efficiency, and cost-effectiveness.
In formulating a value-based care adoption strategy, it’s essential to balance short-term gains with building a foundation for long-term success. Providers should prioritize initiatives that not only maximize immediate financial incentives but also lay the groundwork for sustainable value-based care delivery. This may involve investing in infrastructure, care coordination processes, and provider education to ensure readiness for risk-based payment models.
Additionally, providers should remain agile and adaptable in their approach, continuously monitoring policy changes and market dynamics to adjust their strategies accordingly. By maintaining a focus on both short-term gains and long-term sustainability, providers can navigate the uncertainty of the Advanced APM Bonus while positioning themselves for success in value-based care.
While I don’t know the future of health policy, I would say that it is universally recognized in the value-based care community that we need strong incentives to continue thus work in accountable care transformation. And that certainly isn’t lost by those at the highest levels of HHS and CMS. If the APM Bonus was decreased to 0.5%, you would have to compare that to the MIPS program maximum bonus at 9%. In what world does it possibly make sense where value-based care is our future and CMS has a goal to have 100% of Medicare beneficiaries in an accountable care relationship, but we do away with the APM Bonus incentive? This is an important issue in the value movement at present and Lumeris is proud to support efforts from NAACOs, APG, and Accountable for Health is advocating for the Value in Health Care Act which, among other things, would reinstate and extend the 5% bonus for two more years to allow providers to invest in the necessary tools to succeed in value-based care.
- ACO REACH — First Dollar Risk and Benchmark Discount: Capturing first dollar risk is the ultimate goal in a value-based Medicare strategy once an organization has developed an advanced level of sophistication in managing population health for aligned populations. The ACO REACH Model offers both partial and full risk sharing options which determine the portion of the savings or losses in relation to the Performance Year Benchmark that accrue to the ACO. No Minimum Saving Rate or Minimum Loss Rate applies to aggregate savings/losses for either the Global or Professional options. As such, all ACOs retain “first dollar” savings or are responsible for “first dollar” losses. In the Global option, there is a Performance Year discount that is made as an adjustment to the benchmark. By applying the discount to the benchmark used for reconciliation of realized spend, the discount increases the savings hurdle that must be realized to avoid shared losses and generate shared savings. How do market disruptors and clinically integrated networks leverage their resources and experience in managing total cost of care to capitalize on first dollar risk? And regarding track selection in ACO REACH…Global versus Professional…how should one evaluate the Performance Year discount in the Global option (along with any other intricacies between the two risk mechanisms) to ensure that an informed decision is made that aligns with an organization’s VBC strategy and risk tolerance?
Great question, Eric. We are definitely seeing the more advanced health systems and physician practices leverage their resources and experience in managing total cost of care to capitalize on first dollar risk by strategically aligning their care delivery models with value-based payment structures. These leading organizations create systems of care to capitalize on the enhanced risk exposure in that first dollar zone. Many, if not most, of the organizations cannot do it on their own, however. That is where an enabling partner like Lumeris is able to provide robust population health management capabilities, advanced analytics, and care coordination infrastructure to identify and address high-risk patients proactively. By effectively managing population health in a co-created system of transformative care, we work together to leverage an extensive value-based infrastructure to mitigate unnecessary utilization, improve care outcomes, and ultimately achieve savings that accrue directly to them as “first dollar” savings.
Now let’s go to your second question. Regarding track selection in ACO REACH, organizations must carefully evaluate the Performance Year discount in the Global option, along with other intricacies between the two risk mechanisms, to ensure an informed decision that aligns with their VBC strategy and risk tolerance. The Performance Year discount increases the savings hurdle that must be realized to avoid shared losses and generate shared savings. Therefore, organizations must assess their ability to meet this increased savings hurdle and weigh it against the potential benefits of the Global option, such as greater flexibility or higher potential savings opportunities.
In evaluating the Global and Professional tracks of ACO REACH, I would recommend that organizations consider factors such as their historical performance, financial stability, provider network makeup, and care delivery capabilities when evaluating their track selection. By conducting a comprehensive analysis of these factors and consulting with internal stakeholders, external experts, and peers, organizations can make an informed decision that optimizes their ability to succeed in the ACO REACH model while aligning with their overall VBC strategy and risk tolerance. Lumeris can play a big role in supporting this consideration. We bring a high level of sophistication when it comes to contracting expertise and understanding important nuances of the payment models to yield optimized risk arrangements.
Overall, we ensure our partners are empowered with the tools, resources, and incentives necessary to prioritize data-driven decision-making on the front-end when it comes to selecting the right payment model or risk track. And once that decision is made, we ensure an optimal outcome through a team effort, incorporating the physicians, their care teams, and wrap around services and technology to provide a system of care that capitalizes on the risk determination that has been made.
- MSSP: The Medicare Shared Savings Program is CMS’ flagship ACO program and an important bellwether for the value movement. It has a track record that spans a decade and many improvements have been made in ACO policies over the years to enhance quality reporting and promote more equitable benchmarking. And there are recent changes such as the new HCC risk adjustment model version (V28) implemented this year that many are still learning more about as the year unfolds. Although there have been changes over the years, this program is very stable and well understood. For organizations newer to value-based care that are getting their feet wet in managing total cost, MSSP remains a strong option as it has guardrails and policies in place to protect participating organizations and provides ample opportunity to achieve shared savings. There are certainly a lot of mechanics to consider in this payment model, and I certainly wouldn’t ask you to go through all of them. However, I would be interested in hearing your overarching perspective on the MSSP as a bridge to risk and what ACOs are experiencing currently in the program. If the contraindications for ACO REACH are lack of value-based readiness and experience to accept advanced levels of risk, what are the indications of MSSP as a viable alternative? What are the main things a healthcare organization should evaluate when considering MSSP participation?
The Medicare Shared Savings Program (MSSP) indeed stands as a stalwart in the value-based care landscape, offering stability and a proven track record spanning over a decade. For organizations newer to value-based care, MSSP serves as a strong option due to its well-established guardrails and policies designed to protect participating organizations while providing ample opportunities to achieve shared savings.
As we look at MSSP as a bridge to risk, it offers a gradual pathway for organizations to transition into more advanced risk-sharing arrangements. The program allows providers to gain valuable experience in managing total cost while operating within a framework that mitigates downside risk exposure. This incremental approach to risk readiness can be particularly beneficial for organizations still building their value-based care capabilities.
When evaluating MSSP participation, healthcare organizations should consider several key factors. Firstly, they should assess their readiness and experience in value-based care practices, including their ability to manage population health, coordinate care effectively, and meet quality reporting requirements. Additionally, organizations should evaluate the potential financial implications of MSSP participation, considering factors such as benchmarking methodologies, upside and downside risk sharing arrangements, and potential shared savings opportunities.
Furthermore, organizations should closely examine the specific tracks and options available within MSSP to identify the best fit for their needs and priorities. Whether opting for an upside-only track to start or considering more advanced risk-sharing arrangements, it’s essential for organizations to align their MSSP participation with their overall strategic goals and risk tolerance.
Overall, MSSP presents a viable alternative for organizations seeking to embark on their value-based care journey. By carefully evaluating their readiness, goals, and the nuances of MSSP participation, healthcare organizations can make informed decisions that position them for success in the evolving healthcare landscape.
- CMS Timeline and Lumeris Call-To-Action: The big takeaway from our discussion today is that healthcare leaders must carefully evaluate the respective benefits and risks associated with participating (or not-participating) in the Medicare Shared Savings Program or ACO REACH as the industry continues to evolve towards more mature levels of delegated risk sharing. Within large networks of providers, it is unlikely that a one-sized-fits-all-approach to participation in these products will be successful in maximizing revenue opportunity and premium capture while minimizing downside exposure, so the Medicare value-based strategy has to be multi-faceted. CMS has announced the application timeline for Medicare ACOs which requires leaders to move swiftly in making the key decisions to participate in either MSSP or REACH for PY2025. Can you provide a brief overview of the CMS timeline requirements as a call to action for those listening today? And how can Lumeris support healthcare leaders in navigating this important strategic decision point while also positioning them with the enablement tools and infrastructure to succeed in the long-term?
The CMS timeline requirements for Medicare ACOs represent a crucial call to action for healthcare leaders. As we discussed in our whitepaper, leaders must move swiftly to make key decisions regarding participation in either the MSSP or ACO REACH for Performance Year 2025.
The timeline typically involves several important milestones, including application deadlines, data submission deadlines, and program start dates. Healthcare leaders need to be proactive in understanding and adhering to these timelines to ensure seamless participation in the chosen program.
At Lumeris, we understand the complexity of these decisions and the importance of strategic planning in value-based care transformation. Our team is dedicated to supporting healthcare leaders in navigating this critical decision point by providing comprehensive guidance and expertise.
We offer tailored solutions and enablement tools designed to help organizations evaluate their options, assess their readiness for value-based care, and develop strategic plans aligned with their goals and priorities. From risk assessment and performance analysis to care coordination and technology implementation, Lumeris provides the infrastructure and support necessary for long-term success in value-based care.
If I could leave you with one takeaway, I would say “Don’t Go This Alone.” Value transformation is really hard work, and the decisions you make in selecting programs have profound strategic implications. Lumeris is here for you if you want to be able to more confidently navigate the CMS timeline requirements and make informed decisions about your Medicare value-based strategy. We specialize in partnering with healthcare providers to enable value-based care success in for all populations via risk-sharing and total-cost-of-care models. We work every day to empower physicians, care team members, and health systems to fulfill the promise of value-based care by developing and executing strategy, operationalizing clinical programs to improve population health and reduce costs of care leveraging our proprietary technology and deep expertise. We not only position our partners for success in the evolving healthcare landscape. Together, we can drive meaningful change and deliver better outcomes for patients and communities.
Thank you, Eric, for hosting this important conversation. And thank you all who attended today’s webinar. Please feel free to reach out to me should you have any additional questions.
Let us know if you have suggestions for future podcast topics or guests.
