Kim Kauffman Explains Moving From MSSP to Medicare Advantage

February 25, 2019

There is a lot involved if an accountable care organization (ACO) decides to switch from Medicare Shared Savings (MSSP) to Medicare Advantage, but Medicare Advantage offers more benefit design flexibility, explained Kim Kauffman, MPH, vice president of value-based care at Summit Medical Group.

There is a lot involved if an accountable care organization (ACO) decides to switch from Medicare Shared Savings (MSSP) to Medicare Advantage, but Medicare Advantage offers more benefit design flexibility, explained Kim Kauffman, MPH, vice president of value-based care at Summit Medical Group.

Transcript

What would be involved in the move to Medicare Advantage, and what are the biggest changes an MSSP ACO would have to make?

So, the move from Medicare Shared Savings Program to Medicare Advantage. So, let’s start with the most simple scenario, which is the provider organization elects to partner with a health plan. If that’s the case, then those changes include things like carefully dovetailing care coordination, so you don’t have ACO coordinators tripping over health plan care coordinators all trying to help the patients—so it’s a good problem to have, but it’s still a problem.

Care coordination staff for the ACO needs to figure out how to tap those supplemental benefits that will improve patient outcomes; also need to double down in risk adjustment. The risk adjustment is a big opportunity to appropriately reflect the entire disease burden of the patient.

Medicare Shared Savings Program there’s no sales per se and in Medicare Advantage there’s this truncated annual enrollment period, so the provider organization would probably want to support their health plan partner in that.

So, that’s the simplest scenario if you want to talk for moving Medicare Shared Savings Program to Medicare Advantage in the context of a provider-sponsored health plan we would need like an hour.

How might involvement in MA improve patient engagement?

So, in Medicare Advantage, the patient selects the health plan and then the patient selects the primary care physician. In other words, the patient’s is intentional. In a Medicare Shared Savings Program the provider elects to participate and then they post notice, and the patient may or may not know if they’re in this Medicare Shared Savings Program thing.

So, the benefit design in Medicare Advantage also is kind of set up to help enhance patient engagement—healthy behavior programs, things like SilverSneakers, that encourage the patient to manage their own conditions. You’ve things as a Medicare Advantage—again benefit design—where they actually cover things like an annual physical that traditional Medicare just does not cover. So, kind of a bit of a hole in terms of preventive care.

And then finally, I believe, Medicare Advantage encourages patient engagement through those supplemental benefits—dental, vision, hearing aids, some of the supplemental that really can enhance the whole patient and their health and well-being.