Coordinated Care Networks Could Be Missing Out on Millions


Accountable care organizations could get millions of dollars in additional payments if they take on greater risk, but health-care stakeholders caution such organizations often are not ready.

Consulting firm Avalere Health’s analysis showed ACOs in the Medicare Shared Savings Program (MSSP) would have gained $886 million in additional payments in 2015 if they took on two-sided risk, under which they take some responsibility for any losses. This includes a 5 percent bonus payment under the Quality Payment Program (QPP). However, over 92 percent of ACOs operate in a one-sided risk track where they bear no risk.

“This study really shows how much incentive there is to take on greater risk,” Allison Brennan, vice president of policy at the National Association of ACOs (NAACOS) in Washington, told me Aug. 3.

ACOsChartACOs are groups of doctors, hospitals, and other health-care providers who work together to increase care coordination, improve patient outcomes, and reduce spending growth. They are part of a larger value-based approach to make Medicare payments based on results and outcomes instead of the number of services rendered.

In 2015, only 42 ACOs were in the two-sided risk Tracks Two and Three options, under which they may be responsible for repaying a portion of shared losses back to the Centers for Medicare & Medicaid Services. Organizations operating in the Track One option could have seen a $1.1 billion increase in payments from the 5 percent bonus payment and a $178 million payment from shared savings if they took on more risk, the study found. While 21 percent of Track One ACOs would have generated $437 million in net losses overall, one-third of them would have offset their losses by the bonus payment.

While the financial incentives for ACOs look good, Brennan told me the risk is still too high for many ACOs.

Read my full article here.

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