In a Health Affairs blog post, Dr. Mark McClellan, who served as the administrator for the CMS from 2004 to 2006, reviewed and commented on several key aspects of the CMS's proposed rule for reforming the Medicare Shared Savings Program (MSSP).
For the program to succeed, he said, CMS must take steps to create greater certainty for program participants, such as transitioning the financial benchmark calculation over time to a combination of an ACO's historical spending on the patients attributed to it and regional spending, gradually moving entirely to a regional spending benchmark. In addition, the current method of patient attribution should be transitioned to one that is more prospective in nature for ACOs that assume a two-sided risk, and these ACOs should have the option of patient attestation at the beginning of each performance year.
Further, CMS should adopt "a full and up-to-date risk adjustment to account accurately for population health status" and payments should reflect changes in the ACO's beneficiaries' health risks. He also suggested that CMS provide claims data on a monthly basis, rather than quarterly, to give ACOs more opportunity to close quality gaps and avoid unnecessary costs.
McClellan further recommended that CMS expand the pathway leading from fee-for-service toward Medicare Advantage's full capitation model not only by adding the proposed Track 3, which increases the two-sided risk implemented in Track 2, but also by adding a Track 4 with a 50 percent captivated payment for historical Medicare Part A and Part B.
Collectively, these steps would largely mirror the Next Generation ACO Model CMS recently announced. McClellan noted that integrating the Next Generation ACO Model with "a set of finalized MSSP financial tracts to form a complete pathway would give ACOs more clarity and confidence about transitioning to increased financial risk over a reasonable period of time."
In addition, McClellan suggested that CMS should support greater beneficiary engagement with the ACOs — for example, by waiving or lowering copays and deductibles for patients who receive care from providers in their ACO and by supporting improved beneficiary education with regard to the ACOs. He also recommended aligning the MSSP with other payment reform models that "support more person-focused care," such as bundled payments, and taking heed of the successful innovations that ACOs in the private sector have implemented.