Reprinted from ACO BUSINESS NEWS, a hard-hitting monthly newsletter on the latest industry actions to design and create ACOs, for hospitals, physicians, health plans and their advisers.
By Jane Anderson, Editor
January 2013 Volume 4 Issue 1
The Medicare Shared Savings Program (MSSP) is expected to more than double in size early in 2013 as CMS adds “several hundred” new accountable care organizations to the program, industry sources say.
In addition, the ACO industry is likely to see early results from both the Medicare Pioneer and MSSP programs sometime in 2013, although some analysts warn not to take those data too seriously. Overall, both providers and CMS are moving full speed ahead to implement accountable care in the Medicare program, even ahead of preliminary data on quality and costs.
“On the horizon, we see substantial growth,” says health care consultant Clif Gaus, who is working with two other consultants to form a new association for ACOs (see box, p. 10). Both providers and insurers view the accountable care model as the future and are investing heavily in it, Gaus tells ABN.
CMS approved 27 organizations in May as part of MSSP and added another 89 in July, bringing the total number of ACOs in the program to 154 and total Medicare beneficiaries served to 2.4 million (ABN 8/12, p. 1). Several sources predict that CMS will add substantially to that number when it announces the MSSP participants joining the program as of Jan. 1, 2013.
Medicare ACOs Catalyze Movement
Most of the groups participating in MSSP to date — and likely most of the groups due to be announced this month — will accept only upside risk. Few really are ready to accept downside risk, says Leavitt Partners Managing Director Andrew Croshaw, who characterizes groups’ forays into the ACO world via MSSP as “a lot of toes in the water.”
Still, MSSP is “clearly a priority for CMS,” and the Medicare program will continue to catalyze the overall ACO movement, he tells ABN.
It’s also likely that CMS will release very early results from both the Medicare Pioneer and the MSSP programs in 2013. “The Pioneers started taking accountability on Jan. 1, 2012, but they didn’t even know which patients they were accountable for until after the first quarter of 2012,” says Croshaw. “The early results will reflect the fact that the Pioneers weren’t exactly sure what their population was. Hopefully people will take the earliest results with a grain of salt.”
Pioneer results should come sooner than MSSP, but the industry may see both in 2013. “There will be a lot of demand to see early results,” says Erik Johnson, senior vice president at Avalere Health. “We may not see statistically significant results, but we should start to see some anecdotal results,” he tells ABN.
Gaus warns that “we won’t see everybody being successful, but some time this summer or fall we will know what the impact of ACOs is on beneficiaries.” If a large majority of MSSPs and Pioneers are shown to be successful, then there will be discussion on how to expand the program nationally, he says. If the data show less success, then that may represent a pause point while “we’re waiting for the early adopters to work through the limitations,” he says.
There likely won’t be evidence of large cost savings from ACOs within the Medicare program for 2013, Gaus says, adding that the target perhaps should be large cost savings several years from now, in 2016 or 2017. However, “it’s not just whether it’s a financial success. There’s an awful lot to be learned about organizational and operational challenges” of running an ACO, he says.
Some already are attempting to address those challenges. For example, Pioneers are trying to persuade CMS to give them more flexibility in how they engage patients, Croshaw says. “They’re used to being able to work more closely with patients, but CMS has been reluctant to allow that.” These observations and requests from both MSSP and Pioneer organizations could result in changes to some of the programs’ rules in 2013.
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