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What you need to know about the Medicare Shared Savings Program (MSSP) performance results

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A data activation platform company, Innovaccer, recently compiled data regarding the performance of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP). The organization’s report, State of the Union Report for Medicare ACOs, details the results of a proprietary algorithm Innovaccer used “to look at the quality, performance, utilization and expenditure data for every region in the U.S., based on the performance of Medicare ACOs participating in the MSSP in program year 2017.”

The study found that ACOs participating in the MSSP have generated $1 billion in savings since their inception. Going forward, the report adds that “adoption of value-based care models is expected to account for 59 percent of healthcare payments by 2020, as the healthcare industry uses value-based care to address these high-cost utilizers.”

As rising healthcare costs are of concern to patients as well as providers, researchers identified the top measures that contribute the most to healthcare expenditure per capita. Nine of the fifty-three parameters affecting the performance of ACOs were found to “the most significant.” Those included: long-term care hospital discharges; COPD or asthma discharges; skilled nursing facility discharges; emergency department visits; MRI events; unplanned admissions for patients with chronic conditions; use of imaging for low back pain; use of statin therapy; and controlling high blood pressure.”

Social determinants of health were also factored into the ACO performance data, “showing the vulnerability of all the states across the U.S. against the social factors affecting their populations.” The study found North Dakota to be the least vulnerable to social determinant factors and Hawaii to be the most vulnerable. Social determinants of health include socioeconomic factors, education level, economic environment, job opportunities, and social supports.

As of July 1, 2019, ACOs may participate in the Shared Savings Program for agreement periods of at least five years, under one of two tracks: the BASIC track (which includes a glide path for eligible ACOs), or the ENHANCED track, which offers the highest level of risk and potential reward. ACOs participating in the BASIC track’s glide path may begin under a one-sided model and progress through incremental levels of increasing risk and potential reward.