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CMS Releases Evaluation Reports on Payment Models Including MSSP, CPC+, ESRD CEC Model, and Dual Eligibles

October 01, 2019

McDermott+Consulting

MSSP Saves $739.4 Million in 2018

Recently released performance results show that the Medicare Shared Savings Program (MSSP) generated $739.4 million in total net savings across 548 accountable care organizations (ACOs) in 2018. In a Health Affairs blog post Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma summarized the findings that ACOs that received shared savings payments had decreases in inpatient, emergency room, and post-acute care spending and utilization, while ACOs that increased spending relative to their targets tended to show increases in these areas. She also noted that almost 11 million Medicare fee-for-service beneficiaries now get care from an ACO.

While originally established in 2011, last December, CMS overhauled the program under a final rule titled, “Pathways to Success.” More information on the 2018 performance results is available here.

CPC+ 2018 Quality and Utilization Performance Results

CMS has posted quality and utilization performance results for 2018 for the Comprehensive Primary Care Plus (CPC+) Model. The posted data summary shows that in 2018 CMS paid $41,528,099.80 in Performance Based Incentive Payments across all regions and 2,874 out of 2,879 of practices met the model’s quality reporting requirement. The complete data report is available to download here.

CPC+ is a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. More information about the CPC+ Model can be found here.

ESRD Care Model Year 2 Financial and Quality Performance Results Posted, Savings Totaled Nearly $1 Million

CMS released the financial and quality results for performance year two (2017) for the Comprehensive End Stage Renal Disease (ESRD) Care (CEC) Model. The 2017 financial and quality report indicates savings totaled $99,251,845 for the second performance year of the CEC Model. These savings are to be split between CMS and participating dialysis organizations meeting benchmark requirements. The complete results are available to download here.

The CEC Model is testing increased care coordination and providing more patient-centered care for beneficiaries with ESRD. Large dialysis organizations are eligible for shared savings payments but are also liable for paying shared losses. Non-large dialysis organizations participate in a one-sided risk track, where they are eligible for shared savings payments but are not liable for shared losses. More information about the CEC Model can be found here.

Evaluation Posted on Payment Models Aligning Financial Incentives for Dual Eligibles

Finally, CMS is currently testing two payment models to enhance the coordination of care and align the financial incentives for beneficiaries enrolled in both Medicare and Medicaid. CMS posted evaluation reports for the following states: Michigan, New York, South Carolina, and Washington.

Under the model, states have the option of participating in either a capitated model or a managed fee-for-service model. In the capitated model, the state, CMS and a third-party payer enter into a contract in which the plan receives a prospective payment to provide comprehensive, coordinated care for beneficiaries enrolled in Medicare and Medicaid. In the managed fee-for-service model, the state and CMS enter into a contract in which the state is responsible to implement initiatives to reduce cost and improve quality for beneficiaries. Currently, 11 states are participating in the program. More information about the initiative can be found here.

 


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Mara McDermott at 202-204-1462 or mmcdermott@mcdermottplus.com.

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