Advancing Risk Capability in 2015: Medicare Shared Savings Program

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Coral Bell
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1 Advancing Risk Capability in 2015: Medicare Shared Savings Program Educational Slides for 2016 Class DHG is the firm that BPA has used to help determine the distribution methodologies for our previous HEP payments. They are based in Charlotte, North Carolina. They have a MSSP group that has provided guidance to the BPA Board and Finance Committees concerning the MSSP application process.

previous HEP payments. They are based in Charlotte, North Carolina.

2 Medicare Shared Savings Program NOW AN ANNUAL ENROLLMENT PROCESS ANOTHER 89 STARTED 1/1/15 As you can see there's really nothing close to the BHS markets. GROWTH IN BENEFICIARIES

3 Fundamentals of the MSSP Program EXPLANATION OF HOW MSSP WORKS AND ARE STRUCTURED. DESIGN ELEMENT The BPA Board Approved Application for the One-Sided Model to start; i.e. no downside risk. ONE-SIDED MODEL TWO-SIDED MODEL SHARED SAVINGS PAYMENT CYCLE Sharing Rate Up to 50% based on quality performance Up to 60% based on quality performance Minimum Savings Rate (MSR) Varies by number of assigned beneficiaries 2% Shared Savings Method First dollar sharing once MSR is met or exceeded First dollar sharing once MSR is met or exceeded Maximum Sharing Cap Total shared savings payments cannot exceed 10% of benchmark Total shared savings payments cannot exceed 15% of benchmark Minimum Loss Rate None ACO repays share of all losses if expenditures are more than 2% higher than benchmark Shared Loss Rate None One minus final sharing rate applied once minimum loss rate is met; loss rate is capped at 60% Maximum Loss Cap None Losses capped at 5%, 7.5%, 10% in years 1, 2, 3, respectively Health Care Advisory Board, 2012

assigned beneficiaries 2% Shared Savings Method First dollar sharing once MSR is met or exceeded First dollar sharing once MSR is met or exceeded Maximum Sharing Cap Total shared savings payments

4 Quality Data Source: MLN Webinar 4/8/14

5 Quality Metrics of the MSSP Program Health Care Advisory Board, 2012

6 Participant List Source: MLN Webinar 4/22/14

7 Beneficiary Assignment >/= 5,000 FFS Medicare patients Source: MLN Webinar 4/22/14

8 Beneficiary Assignment and Exclusivity PCP : internal medicine, general practice, family practice, and geriatric medicine STEP 1: A beneficiary who sees a PCP affiliated with an ACO will be assigned to the ACO if Medicare charges for PCS furnished to the beneficiary by the ACO s PCP exceed the PCS charges of PCPs outside the ACO STEP 2: if a beneficiary does not see a PCP, then beneficiary will be assigned to ACO if the beneficiary received PCS from physician specialists, PAs, NPs, and CNSs (rather than PCPs)

beneficiary by the ACO s PCP exceed the PCS charges of PCPs outside the ACO STEP 2: if a beneficiary does not see a PCP, then

9 Beneficiary Communication Source: MLN Webinar 4/8/14

10 Aggregate & Patient Level Data From CMS Health Care Advisory Board, 2012

11 ACO Early Financial Results TO DATE, MSSP AND PIONEERS HAVE GENERATED $817M OF SAVINGS WITH $372M RETURNED IN SAVINGS PIONEERS: second year was better than first year ($96M vs $87M). Achieved a 1% lower spending trend overall for the Medicare population vs FFS. Almost 1/3 of original participants have left the program MSSP ACOS: Almost 25% of 2012/2013 participants were able to share savings of over $300M. Another quarter reduced spending but not enough to share savings. One ACO overspent by $10M and owed $4M back. These MSSP results were from the first iteration; i.e. when you could start upside only but had to assume risk in subsequent years. We can now stay upside only. Source: McClellan, M.B., Kocot, L., White, R. Katikaneni, P., Medicare ACOs, Continue to Improve Quality,Some Reducing Costs. Brookings.9/22/14.

Almost 1/3 of original participants have left the program MSSP ACOS: Almost 25% of 2012/2013 participants were able to share savings of over $300M.

12 ACO Early Quality results OVERALL HIGHER AVERAGE PERFORMANCE: PIONEER ACOS: all reported quality and mean quality scores increased 19% and overall improvement on 28 of 33 quality measures. Also reported improved average performance scores for patient and caregiver experience for 6/7 measures. MSSP ACOS: improved in 30 out of 33 measures and overall increase in patient experience over FFS. Also achieved higher average performance on 17/22 GPRO measures. 9 MSSPs failed to report quality scores: 4 of which would have qualified for shared savings Source: McClellan, M.B., Kocot, L., White, R. Katikaneni, P., Medicare ACOs, Continue to Improve Quality,Some Reducing Costs. Brookings.9/22/14.

MSSP ACOS: improved in 30 out of 33 measures and overall increase in patient experience over FFS. Also achieved higher average performance on 17/22 GPRO measures.

13 2016 Cohort Deadlines Done Done In Process Source:

Medicare accountable care organization (ACO) update

Medicare accountable care organization (ACO) update April 4, 2013 David Glass and Jeff Stensland Today s presentation Background Description of ACO models in Medicare Strengths and weaknesses of ACOs vs.