The proposed changes to the Medicare Shared Savings Program could prevent the program from driving broad change to value-based care across the country, according to Katherine Schneider, MD, MPhil, FAAFP, president and CEO of Delaware Valley ACO.
The proposed changes to the Medicare Shared Savings Program could prevent the program from driving broad change to value-based care across the country, according to Katherine Schneider, MD, MPhil, FAAFP, president and CEO of Delaware Valley ACO.
Transcript
What is the greatest challenge you see with CMS’ proposed changes to the MSSP?
The Pathways to Success proposed rules changes have a couple of really major concerns, and I think the biggest one is really the impact not on folks like me, who’ve been in the program for 5 years, but it’s on those who are either new entrants or are considering getting in.
Two things. Number 1, the accelerated pace to taking downside risk, the proposal of it being 2 years is just not viable at all. Having gone through being in the program, and actually I was part of the demonstration project 10, 15 years ago that was the precursor, you don’t even know your first-year performance until after the time that you would have to commit to taking downside risk in year 3. That’s just not viable. Let alone have any cash flows. Certainly not viable from a responsible business due diligence perspective.
And the second is the attractiveness of coming in. The gain sharing proportion being reduced from 50% to 25%. I can say with absolute certainty that if those 2 rules had been in effect and with the lack of ability to do things like a Medicare Advantage plan can do in terms of benefit design, in terms of risk adjustment, there’s no way we would have gone into the program. And we’re one of the biggest ACOs in the country. And we committed to this model. And I personally believe that it’s capable of driving broad change across the country in a way that niche programs really can’t do.
So, my biggest concern is really that if we focus just on, “well, the program will just serve a couple of high-performing ACOs,” you’re going to have a great program that nobody is in. And that’s a real concern.
There are other smaller issues around operational things, like beneficiary notifications, going backwards on that. But I really think holistically, for the country, the proposed rules are going to result in a step backwards on the path to value.
Standard Criteria for Loss of Ambulation Needed in DMD
April 19th 2024A recent study suggests the differences between ambulation definitions for patients with Duchenne muscular dystrophy (DMD) can impact the identification of ambulant vs nonambulant individuals, and standard criteria across settings are needed.
Read More
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
An Overview of Health Care and Pharmaceutical Trends, 2023-2024
April 19th 2024Douglas M. Long, BA, MBA, was featured as the keynote speaker on the closing day of The Academy of Managed Care Pharmacy 2024 annual meeting, with a session dedicated to surveying the health care and pharmaceutical trends of the last year.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
Collecting SDOH Data Can Assess Risk of Medical Nonadherence, Improve HEI and Star Ratings
April 18th 2024At the Academy of Managed Care Pharmacy (AMCP) 2024 annual meeting, a panel of presenters explored changes coming to Medicare that incorporate social determinants of health (SDOH) data to improve patient and health system outcomes.
Read More