Dr Rob Fields Discusses Why More ACOs Might Turn to Medicare Advantage

The push to get accountable care organizations to take on risk faster could lead to more participation in Medicare Advantage, said Rob Fields, MD, assistant profession, family medicine and community health, Icahn School of Medicine at Mount Sinai, and senior vice president, chief medical officer, population health at Mount Sinai Health System.

With the proposed changes to MSSP, could we see more commercial ACO contracts?
I certainly think we’ll see a growth and a continued movement toward Medicare Advantage, certainly in the world of value. And I say that because for systems that are working in this space, the rules around how Medicare Advantage risk works compared to the Medicare fee-for-service value tracks, the rules are a lot fairer in Medicare Advantage. It’s easier to get the business operations in line with the clinical operations in Medicare Advantage.

So, while that shift already occurs, there are certainly many systems that have taken a Medicare Advantage-only approach, I think that will only get worse. Meaning: a lot more Medicare Advantage and, perhaps, less concentration on regular fee-for-service value contracts. Just because the rules will be too difficult to navigate.

Research has shown that ACOs that have been doing it longer, do better. Is the proposed 2-year timeline to take on risk in MSSP enough time to get it right?
I think the data is really clear that 2 years is probably not enough, that it takes somewhere in the neighborhood of 3 to 4 years to see a system start to perform under these value-based arrangements. Two years, frankly, feels somewhat arbitrary, and not really demonstrating what the data would show.

I do think it’s going to be a problem and leads to the idea that I think it would be difficult for new ACOs that have not been in this space before. You don’t just wake up one day knowing how to take on value and how to take on risk and how to do this kind of work. It takes some time. And we know, actually at this point, how much time it kind of takes for most systems. So, it would be, I think, somewhat more helpful and more effective to design the rule and the path toward risk to be in line with what, actually, the data shows.
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