Healthcare consulting firm Avalere Health expects that "providers will feel increasingly comfortable with assuming financial risk in exchange for larger incentives" as more than 9 million Medicare beneficiaries will be covered by a total of 480 accountable care organizations (ACOs), including 99 new participants, in the Medicare Shared Savings Program (MSSP).
The number of ACOs participating in the Next Generation ACO Model launched by the CMS Innovation Center more than doubled from 17 last year to 45 this year.
- Of the 525 total ACOs serving Medicare beneficiaries, 87 are in risk-sharing arrangements that will result in financial losses if they fail to meet certain cost benchmarks.
Expansion of MSSP and growth in the number of risk-sharing ACOs is due in large part to the passage of MACRA, which is accelerating the trend toward value-based initiatives through the Quality Payment Program. So far, it seems that MSSP has been successful saving a total of $466 million in 2015 and more than $1.29 billion total since 2012.
As Congress considers health reform, there is some doubt surrounding the future of value-based initiatives like MSSP, which was established by the ACA. One reform floated by Republican leadership could be detrimental to progress made toward value-based care.
House Speaker Paul Ryan (R-WI) has perhaps been the biggest proponent of transforming Medicare into a premium support program, an idea he floated in the “A Better Way” plan he released last year. This approach would cause Medicare to function more like traditional markets, which would increase financial responsibility borne by beneficiaries and leave improvements to market forces rather than government regulators, according to an article published by the New England Journal of Medicine in February 2015.
On the other hand, using payment and organizational reforms to accelerate growth of ACOs, value-based purchasing, and bundled payments would concentrate accountability for improving quality and reducing costs on the government and providers, David Blumenthal, president of the Commonwealth Fund, wrote with his co-authors.
A change of the guard at the executive level could also present a challenge for value-based care initiatives. Recently appointed HHS Secretary Tom Price criticized the CMS Innovation Center during his time as a congressman and knocked bundled payments during his confirmation hearing, as the Advisory Board reported.
While supporters of value-based care initiatives have cause for concern, it is not a certainty that recent progress will be reversed. If the 2015 vote for MACRA was any indication, there is significant bipartisan support for the transition to value-based care. Only 37 Representatives in the House voted against the law compared with 392 who voted for it and it had 92 supporters in the Senate compared with 8 detractors.