Many of the accountable care organization (ACO) models are being tested to find changes to make to the Medicare Shared Savings Program, but there is a general problem with short-lived models ending and being replaced by new ones, said Michael Chernew, PhD.
Many of the accountable care organization (ACO) models are being tested to find changes to make to the Medicare Shared Savings Program, but there is a general problem with short-lived models ending and being replaced by new ones, said Michael Chernew, PhD, Leonard D. Schaeffer Professor of Health Care Policy and director of the Healthcare Markets and Regulation Lab at Harvard Medical School; chair of the Medicare Payment Advisory Commission; and co-editor-in-chief of The American Journal of Managed Care®.
CMS has been testing ACO models for years now. Will the testing ever be over or is the continuous testing of new models the purpose?
There is something permanent in place: the Shared Savings Program. And the way I think of a lot of this testing is to think of things that might move into the Shared Saving Program, overall. So, I'm not sure the health care system will ever not be learning. I do think it's important for them to build models that don't get tested, and then sunsetted, and they have to put in place replacements.
And I think that's been a general problem in this paradigm, which is the models of limited lifespans, and when they sunset—if they sunset—they need to develop a successor model. You've seen a lot of that: CHART [Community Health Access and Rural Transformation Model] was the successor to AIM [ACO Investment Model]. And the direct contracting, in some way, was the successor to the Next Gen [Next-Generation ACO Model]; Next Gen, in many ways was the successor to Pioneer [ACO Model].
And that sequencing of successor models, I think, has created some churn and uncertainty in the system. And I think they will work increasingly, to build some of the things they learn into the Medicare Shared Savings Program, which was created in statute in the [Affordable Care Act] and doesn't really fit this same testing-diffusion paradigm.