ACOs are increasingly moving into two-sided risk options with MSSP BASIC E and ENHANCED. The Direct Contracting model (with both Professional and Global options) introduces new opportunities and flexibilities that are not included in other CMMI models or through the MSSP. Prospective participants must act now to evaluate their model options in preparation for the 2022 performance year, with both MSSP and DC application cycles quickly approaching. CMS will soon reopen the MSSP for the 2022 performance year, and the application period for DC’s second and final cohort is also expected to open around in Spring 2021, according to CMMI’s latest timeline.  Now is the time for organizations to evaluate options and make decisions.
 To aid in that analysis and decision-making, the ACLC and Lumeris partnered together to develop an intelligence brief (coming soon) that is also the focus of this podcast episode. The brief is designed to help provider organizations who are ready to take on significant levels of downside risk to judiciously evaluate the available options, consider the general opportunities and risk associated with the models, compare the methodological differences between MSSP BASIC Level E and MSSP ENHANCED with DC Professional and DC Global, and assess organizational fit. We share detailed comparisons across 7 key areas:  


Participant Eligibility 
Beneficiary Attribution 
Financial Benchmarking 
Quality Performance 
Payment Models 
Financial Settlement  
Additional Benefits 

Our guest this week is Rick Goddard, Senior Director of Market Strategy at Lumeris. Rick is a subject matter expert on value-based payment models and primarily serves as an enterprise strategist. Prior to joining Lumeris, Rick served as the Director of Clinical Innovation at Advocate Physician Partners / Advocate Health Care where led the Clinical Innovation Team. His in-depth operational and consulting experience makes him the perfect guest to help organizations considering their next step on this race to value! 
(Information coming from CMS is ongoing and any opinions are not necessarily those of Lumeris, the Accountable Care Learning Collaborative, or our research associate Leavitt Partners.)
Access the transcript for this episode here.

Glossary of Acronyms:

MSSP – Medicare Shared Savings Program
ACO – a contracted entity in the MSSP
DC – Direct Contracting (new CMMI payment model)
DCE – a contracted entity in the DC model
APM – Alternative Payment Model
MA – Medicare Advantage
CMS – Centers for Medicare and Medicaid Services
CMMI – Center for Medicare and Medicaid Innovation
TIN – Tax ID# (ACO participants in the MSSP are contracted by TIN)
NPI – National Provider ID # (DCE participants are contracted by the individual NPI)

 

Episode Bookmarks:

4:50 Rick Goddard explains his personal connection with mental health and how that informs his “Why”

6:00 Finding balance and lessons learned from training for the Ironman World Championship

7:00 “What excites me is that value is starting to get momentum in the environment, and that thaws out providers and forces them into the game.”

8:50 The accomplishments of the MSSP (growth, building a bridge to risk, and $2B in savings to date)

11:30 The early years of the Pioneer and MSSP ACO programs and what we learned as an industry

12:30 “The upside-only ACO opportunity didn’t have the teeth, nor did the program offer effective levers for us to succeed in managing the total cost of care.”

12:40 MSSP Challenges (e.g. beneficiary complaints and CCLF opt-outs, delays in data sharing, “black box” reconciliation)

14:00 “There weren’t enough managed care-like designs to assist MSSPs to progress in risk.”

14:40 CMS offering incentives for ACOs to accept risk (e.g. SNF 3-day rule, Telehealth waivers, an availability to work with a prospective attribution model)

15:00 “Up until the Next Generation ACO,

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