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National Association of ACOs Fall 2018
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Dr Joe Antos: Proposed MSSP Changes Not a Major Shift in Policy for ACOs
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Dr Rob Fields Discusses Why More ACOs Might Turn to Medicare Advantage
October 21, 2018
Stephen Nuckolls Outlines His Greatest Challenges and Opportunities of the Proposed MSSP Changes
October 22, 2018
Dr Katherine Schneider Highlights How Proposed MSSP Changes Build Stability Into Program
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Allison Brennan Highlights Areas of Opportunity With Proposed MSSP Changes
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Dr Rob Fields: Proposed MSSP Changes Likely to Stifle ACO Movement, Increase Consolidation
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Dr Clif Gaus Discusses Measuring MSSP ACOs Savings
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Dr Joe Antos: Attention Needs to Be on the Future Sustainability of Medicare
November 03, 2018
Dr Katherine Schneider: MSSP Proposed Changes Will Be a Step Back on Path to Value
November 07, 2018
Stephen Nuckolls Discusses What May Change Under the Proposed Pathways to Success
November 10, 2018
Allison Brennan Outlines the Greatest Challenges of the Proposed MSSP Changes
November 11, 2018
Dr Rob Fields Highlights Areas for Continued Innovation With ACOs
November 17, 2018
Dr Joe Antos Dissects the Challenge of Addressing Drug Prices
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Allison Brennan Discusses Impacts of Certain Proposed Changes to the MSSP
November 24, 2018

Kim Kauffman Outlines Benefits of Medicare Advantage Participation for ACOs

Medicare Advantage (MA) provides accountable care organizations (ACOs) with benefits that aren’t available in Medicare’s ACO program, explained Kim Kauffman, MPH, vice president of value-based care at Summit Medical Group.

Medicare Advantage (MA) provides accountable care organizations (ACOs) with benefits that aren’t available in Medicare’s ACO program, explained Kim Kauffman, MPH, vice president of value-based care at Summit Medical Group.


Why should ACOs be involved in Medicare Advantage? What benefits does it have over the Medicare Shared Savings Program?

I think that Medicare advantage has some levers to control the total cost of care that are just not available in the Medicare Shared Savings Program [MSSP] ACOs. Things like there’s contracted network providers, there are levers that have to do with prior authorizations and or referral patterns that are quite helpful in controlling the total cost of care. Contracted rates is huge—total cost of care is a function of both utilization and contracted rates and so in MA you have more room. The other thing piece I think, particularly from a patient perspective, Medicare Advantage has supplemental benefits that are avaible to the patients that are just not there in traditional Medicare.

There’s some other levers in Medicare Advantage that are not avaible in MSSP and those would have to do with the top line, risk adjustment for example. There’s no top end, there’s no maximum risk adjustment in Medicare Advantage the way there is in Medicare Shared Savings Program. There are, however, 2 downward adjustments and risk adjustment for Medicare Advantage because risk adjustment is outpacing risk adjustment in fee for service.

Also, in terms of cash flow if an organization chooses to partner with a health plan there is much less cash outlay than there is in a Medicare Shared Savings Program, where the provider organization is doing it all on their own. Finally, in shared savings in the Medicare Advantage context you are actually in a position where you can negotiate what is the threshold, what is the upside, what is the downside split. And, certainly, what comes down from the hill in Medicare Shared Savings Program that that is what it is.

Final point I would make though is that while Medicare Advantage has some opportunities to better control total cost of care, not all patients are going to want to be in a Medicare Advantage plan and that’s why I think it’s important that provider organizations have a strategy that includes some element of Medicare Shared Savings Program and MA.

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