What is a Medicare MSA plan?
The Medicare Shared Savings Program (MSSP) is designed to provide high-quality, coordinated care to improve outcomes and reduce costs. Eligible providers, hospitals, and suppliers may participate in shared-savings programs by creating or participating in an Accountable Care Organization (ACO).
Should I choose a Medicare Advantage plan?
Medicare Savings Programs You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) deductibles, coinsurance, and copayments if you meet certain conditions.
Does Medicaid have copay or cost sharing?
Medicare Shared Savings Program Accountable Care Tuality Health Plan Services ACO What is an ACO? Tuality Health Plan Services (THPS) Accountable Care Organization (ACO) gives you access to health care from great providers and hospitals throughout the Portland Metro.
Does a Medicare Advantage plan replace original Medicare?
As of January 1, 2020, there are 517 Medicare Shared Savings Program (Shared Savings Program) ACOs . serving approximately 11.2 million Medicare fee-for-service (FFS) beneficiaries across the country. Thirty-seven percent of ACOs are participating under two-sided shared savings and shared losses models.
How do shared savings work?
Shared savings is a payment strategy that offers incentives for provider entities to reduce health care spending for a defined patient population by offering them a percentage of any net savings realized as a result of their efforts.
What is the difference between an ACO and MSSP?
The MSSP is a permanent ACO program in traditional Medicare that provides financial incentives for meeting or exceeding savings targets and quality goals. The MSSP program has multiple tracks that allow ACOs to choose between sharing in both savings and losses, or just savings.
When did the shared savings program start?
2012MSSP began in 2012 with two participation options, Track 1 and 2. MSSP Track 3 was added in 2016, and Track 1+ was added in 2018. CMS created a new program structure for MSSP in 2019 that the agency calls "Pathways to Success".
How does a Medicare ACO work?
An ACO is a group of health care providers who take responsibility for the total cost and quality of care for their patients, and in exchange they can receive a portion of the savings they achieve. An ACO agrees to work together with Medicare to give patients the best possible care.
How does ACO shared savings work?
Shared Savings Program An ACO agrees to be held accountable for the quality, cost, and experience of care of an assigned Medicare fee-for-service (FFS) beneficiary population. The Shared Savings Program has different tracks that allow ACOs to select an arrangement that makes the most sense for their organization.
Is an ACO only for Medicare?
Although starting as a public option under Medicare, ACOs have also grown into a force in the commercial payer market. Many ACOs have multiple contracts with payers, including Medicare and one or more private insurance companies.
Do Medicare beneficiaries need to be notified that their physician is participating in a Medicare Shared savings Program ACO?
Individuals enrolled in Medicare Advantage plans under Part C, an eligible HMO organization under section 1876, or a PACE program cannot be assigned to an ACO. Medicare ACOs must notify patients that they are participating in an ACO.
What is the intent of an ACO?
An accountable care organization (ACO) is a group of doctors, hospitals, and other health care providers that work together on your care. Their goal is to give you -- and other people on Medicare -- better, more coordinated treatment.
What is fee-for-service Medicare?
What is fee-for-service? Fee-for-service is a system of health care payment in which a provider is paid separately for each particular service rendered. Original Medicare is an example of fee-for-service coverage, and there are Medicare Advantage plans that also operate on a fee-for-service basis.
Do patients know they are in an ACO?
Nobody—not your doctor, not your hospital—can tell you who you have to see. Is an ACO a Health Maintenance Organization (HMO), managed care or an insurance company? No.
How do patients benefit from ACO?
The patient community gains a wide number of advantages including improved outcomes, better quality of care, greater engagement with providers, and an overall reduction in out-of-pocket costs. Health payers see significant cost savings from the program once risk-based contracts have been initiated.
What is an ACO vs PPO?
There are a number of important similarities and differences between ACOs, HMOs (Health Maintenance Organizations), and PPOs (Preferred Clinician Organizations): An ACO is generally based on a self-defined network of clinicians, whereas in most HMOs and PPOs, the network is defined by a health plan.
What is MSSP in Medicare?
That’s the primary goal of the Medicare Shared Savings Program (MSSP). The MSSP is an alternative payment model in which eligible providers, hospitals, and suppliers are rewarded for achieving better health for individuals, improving population health, and lowering growth in healthcare expenditures.
Can Medicare beneficiaries choose any provider?
Medicare beneficiaries can continue to choose any provider who accepts Medicare—even if that provider is not part of the ACO. However, beneficiaries benefit from seeing providers in the ACO network because these providers all have a vested interest in providing coordinated, high-quality care.
What is ACO in MSSP?
Coming together to effect change. In the MSSP, teamwork is paramount. To participate, providers must be part of an Accountable Care Organization (ACO), a patient-centered network that shares financial and medical responsibilities with the goal of improving patient care while limiting unnecessary spending.
What is ACO in healthcare?
To participate, providers must be part of an Accountable Care Organization (ACO), a patient-centered network that shares financial and medical responsibilities with the goal of improving patient care while limiting unnecessary spending.
What is next generation ACO?
A Next Generation ACO is similar to a traditional ACO; however, participants assume a higher level of financial risk. To be eligible for incentive payments under MIPS, physicians must receive 25% of their Medicare Part B payments or see 20% of their patients through the advanced APM.
How many quality measures are required for ACOs?
To be eligible for any shared savings that are generated, ACOs must also meet the established quality performance standards for 31 quality measures (29 individual measures and one composite that includes two individual component measures). These MSSP quality measures span the following four quality domains:
What is an ACO?
Each ACO must also create a governing body that represents providers, suppliers, and beneficiaries. An ACO is also responsible for routine self-assessment , including monitoring the care that Medicare patients receive and continually improving processes and outcomes.
What is the key tenet of MSSP?
The key tenet of the MSSP is the use of quality performance measures by ACOs. It is certainly a tricky task as providers are expected to link financial performance with quality. The CMS says that quality measures must focus on continuous improvement, and it revolves around these three goals:
What are the measures of clinical quality?
There are 33 measures used to measure clinical quality, and they include four sections: 1 Preventive Health 2 At-risk Populations 3 Patient and Caregiver Experience 4 Care Coordination and Patient Safety
What is Medicare Shared Savings Program?
Shared-savings programs are perhaps the most advanced and most effective set of value-based payment programs that hospitals can participate in today. The Medicare Shared Savings Program (MSSP) is designed to provide high-quality, coordinated care to improve outcomes and reduce costs.
What is MSSP in healthcare?
The Medicare Shared Savings Program (MSSP) is designed to provide high-quality, coordinated care to improve outcomes and reduce costs. Eligible providers, hospitals, and suppliers may participate in shared-savings programs by creating or participating in an Accountable Care Organization (ACO).
How many Medicare beneficiaries are covered by ACOs?
Introduced in 2012, the Medicare Shared Savings Program (MSSP) is a voluntary program established by the Affordable Care Act. At present, over 7.7 million Medicare beneficiaries are covered by ACOs.
How are ACOs paid?
ACOs are paid through shared-savings contracts, which are similar to bundled-payment contracts. The major difference between them is that payment under bundled-payment contracts is for an episode of care for a single patient, but payment under shared-savings contracts is for the total cost of care for a given population across a given period, ...
Tuality Health Plan Services ACO
Tuality Health Plan Services (THPS) Accountable Care Organization (ACO) gives you access to health care from great providers and hospitals throughout the Portland Metro. Together our goal is to provide you with an excellent patient experience and high-quality care that is more coordinated and less complex.
OHSU and Tuality Healthcare
OHSU Health is the health system that includes OHSU Healthcare, Adventist Health Portland and Hillsboro Medical Center (formerly Tuality Healthcare).
When will telehealth be available in 2020?
With the passage of the Bipartisan Budget Act of 2018, new flexibilities were granted for physicians and practitioners in certain ACOs in the delivery of services through telehealth for dates of service on or after January 1, 2020. Providers and suppliers in ACOs that are in a two-sided risk track and that choose prospective assignment may bill ...
What is ACO in healthcare?
Participation in a Shared Savings Program Accountable Care Organization (ACO) creates incentives for health care providers to work together to treat an individual patient across care settings, including doctor’s offices, hospitals, and long-term care facilities.
What is voluntary alignment?
Voluntary alignment is the process that lets Medicare FFS beneficiaries select, or “voluntarily align” with, a primary clinician. ACOs must notify beneficiaries of their ability to, and the process by which, he or she may identify or change the person he or she chose for the purposes of voluntary alignment.
Medicare Shared Savings Program
Coming Together to Effect Change
- In the MSSP, teamwork is paramount. To participate, providers must be part of an Accountable Care Organization (ACO), a patient-centered network that shares financial and medical responsibilities with the goal of improving patient care while limiting unnecessary spending. The MSSP requires ACOs to promote evidence-based medicine, engage beneficiaries, report internall…
Financial Risk and The MSSP
- To understand truly understand the role of ACOs in the MSSP, one must understand the concept of financial risk. It’s the idea that ACOs in the MSSP can—and should—take on some degree of responsibility for lowering costs (i.e., ensuring that actual expenditures don’t exceed updated historical benchmark data). When they don’t accomplish this goal, they may be penalized. Howe…
Quality and The MSSP
- To be eligible for any shared savings that are generated, ACOs must also meet the established quality performance standards for 31 quality measures(29 individual measures and one composite that includes two individual component measures). These MSSP quality measures span the following four quality domains: 1. Patient/caregiver experience 2. Care coordination/pa…
The MSSP from The Beneficiary’S Perspective
- Medicare beneficiaries can continue to choose any provider who accepts Medicare—even if that provider is not part of the ACO. However, beneficiaries benefit from seeing providers in the ACO network because these providers all have a vested interest in providing coordinated, high-quality care.
Important Considerations in The MSSP
- There are several other important concepts to consider when joining an ACO as part of the MSSP. The article, What is an Accountable Care Organization (ACO), provides great insights into some overlying concerns with ACOs today. “Since the inception of ACOs in 2012, many are reaching the limit of their no-risk contracts and are considering whether they want to continue with the Medic…
The Role of The Medicare Shared Savings Program
How Do Providers earn?
- First, only ACOs that serve a minimum of 5,000 Medicare beneficiaries are eligible. All providers must: 1. Promote beneficiary engagement and evidence-based medicine. 2. Provide internal reports on quality and cost metrics. 3. Provide coordinated care across and among specialists, primary care physicians, and acute/post-acute providers. Here are a few things for providers to n…
MSSP Performance and Quality Measures
- The key tenet of the MSSP is the use of quality performance measures by ACOs. It is certainly a tricky task as providers are expected to link financial performance with quality. The CMS says that quality measures must focus on continuous improvement, and it revolves around these three goals: 1. Improved care for patients 2. Improved health for populations 3. A reduction in expendi…
Final Words
- The MSSP will continue to evolve, although it is important to note that setting up an ACO costs an average of $1.6 million. The government has actively sought to improve the programover the last few years; we are interested to see whether the new administration will continue along this path.