Palliative care providers that form collaborative partnerships with Accountable Care Organizations (ACOs) may be lending to a landmark downward trend in health care spending in the value-based payment landscape.
The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced that its Medicare Shared Savings Program (MSSP) yielded more than $2.1 billion net savings in 2023 — the largest amount in the program’s inception more than a decade ago, according to the agency.
ACOs participating in MSSP earned an estimated $3.1 billion in shared savings payments during the program’s 2022 to 2023 performance year, the highest dollar amount thus far, CMS reported.
“We continue to be encouraged and inspired by seven consecutive years of savings and high-quality care, with 2023 being the strongest year of performance to date,” said Dr. Meena Seshamani, CMS Deputy Administrator and director of the Center for Medicare, in an announcement.
As of January 2024, roughly 480 ACOs are participating in MSSP, which include more than 608,000 clinicians who provide care to nearly 11 million Medicare beneficiaries. Organizations participating in the MSSP program receive advance payments on their anticipated shared savings if they have shown if they have a “history of success” in the program.
ACOs are groups of physicians, hospitals and other health care providers who voluntarily join forces to provide coordinated care to their Medicare patients, with a focus on quality and cost savings. Palliative care and hospice providers can collaborate with ACOs by becoming members of those organizations themselves, or by contracting with them through a preferred provider network.
In the MSSP model, ACOs that generate cost savings for Medicare can receive a portion of that amount in return. A portion of these savings can then be passed on to a palliative care or other provider participating in or contracted with the ACO.
CMS indicated plans to strengthen the shared savings program as part of its larger goal to ensure 100% Medicare beneficiary enrollment in an accountable care relationship by 2030. The agency will continue exploring the test of payment models such as MSSP and add new components designed to increase participation, the agency indicated in the announcement.
“We are taking steps to continue to grow this impactful program to ensure those we serve have access to high-quality, affordable health care, no matter where they live,” Seshamani said.
The interdisciplinary services that palliative care providers offer may be having substantial impacts on the reduced trends in total cost of care, according to Dr. Josh Lowentritt, primary care physician and nephrologist. Lowentritt is also senior medical director of Aledade, a network of ACO primary care organizations. The company works with 1,900 primary care practices across 45 states and in the District of Columbia providing care to more than 2.5 million patients annually.
Palliative care providers’ value proposition in the ACO realm in part centers around the potential for their services to yield reduced rehospitalizations and lower health care costs as a patient’s serious illness progresses, Lowentritt indicated.
“When thinking about palliative care’s value proposition in a value-based setting, there’s a couple of areas that really reinforce the mutual benefits for palliative care physicians and other clinicians in value-based care arrangements such as an ACO and MSSP,” Lowentritt told Palliative Care News. “Thinking about total cost of care, palliative care clinicians ideally would want to be in a value-based care model to understand and get data on where excess suffering and spending may be occurring and how they can impact it.”
Palliative care providers in value-based arrangements such as MSSP have a large window into Medicare claims data with the ability to view trends in health care spending by geographic region and by service type. Having access to these data can help providers understand where the greatest underserved areas exist and services that may be beneficial to expand upon in those regions, Lowentritt explained.
Forming an ACO collaboration may bear fruit for palliative care providers as future value-based reimbursement trends take shape, particularly in the MSSP program, according to Lowentritt.
“Palliative care clinicians who are involved with an ACO can really help an organization to meet their patients’ needs,” he said. “In an ACO, clinicians need to know if patients who have an advanced illness are able to receive palliative services and if they’re satisfied with them as part of their accountability. ACOs are required to measure patient satisfaction under MSSP as well as many other value-based [arrangements]. Higher patient satisfaction does actually drive some of the reimbursement and leads to higher payments.”
