MedPAC looks for ways to make ACO better save money


Medical insurance payment consultants agreed at Monday’s meeting whether it is worthwhile to explore whether it is worthwhile to explore the administrative method to set a factor to predict the cost trend of responsible medical organizations, and whether it can make it easier for high-performing organizations to share savings every year. However, the group questioned whether it is possible to establish a viable benchmark system for ACO in the voluntary program.

This may lay the foundation for future Medicare Payment Advisory Committee meetings on mandatory ACO participation and indicate that MedPAC members are moving in the same direction as the Medicare and Medicaid Services Center, the latter said in a statement October White Paper Its goal is to have all medical insurance beneficiaries in value-based care arrangements by 2030.

ACO is made up of doctors, hospitals and other providers who are committed to coordinating the care of health insurance beneficiaries. Providers’ participation in ACO is voluntary. Participants can receive bonuses based on the extent to which they help save the medical insurance plan and their quality performance.

If the beneficiary’s expenditure is lower than the specified benchmark level, the ACO can share the medical insurance savings. The benchmark is based on the expenditures of beneficiaries who are eligible for ACO in the base year and the ACO’s expenditure growth between the base year and the performance year.

Since the ACO benchmark will be reset in each performance period based on the past performance of the ACO, the ACO that increases the annual savings will have to deal with benchmarks that are increasingly difficult to surpass.

MedPAC staff warned at a meeting on Monday that this effect is called the ratchet effect, which puts long-term participation in ACO at risk by reducing the incentive for ACO to create savings.

In order to directly address the ratcheting problem, MedPAC staff recommends the use of administratively set trend factors, which can be based on many indicators, including discounted forecasts of growth in medical insurance pay-for-service expenditures or projected GDP growth.

This will eliminate the ratcheting effect, but it brings its own challenges, including the fact that expenditure forecasts may not always be correct. ACOs, especially smaller ones, may be positively or negatively affected by one-off changes in expenditures, practice patterns, etc., which may cause ACOs with unsatisfactory benchmarks to withdraw from the program.

Nevertheless, the majority of members agreed that MedPAC should study how to get rid of the ratchet effect, and expressed that they hope to explore the administrative setting of trend factors as a way to eliminate this phenomenon.

However, many members questioned whether it is possible to create a better benchmark system if the ACO program is still voluntary.

MedPAC Commissioner Dr. Jonathan Jaffery said that part of the reason why it is difficult to balance the efficiency of reward providers, the goal of generating Medicare plan savings, and not inhibiting participation in ACO is partly because of voluntary participation in the plan.

Jaffery said that in his perfect world, every Medicare beneficiary is included in a value-based payment model, whether it is Medicare Advantage or ACO.

Commissioners including Betty Rambor and Bruce Pyenson said that there should be some urgency behind the move to include ACO as a standard for health insurance payments.

“Like everyone else, I don’t see a solution in the voluntary system. [I think] Some form of mandatory or quasi-mandatory system is essential,” Pyenson said.

Paul Ginsburg, vice chairman of MedPAC, stated that he envisioned the establishment of an organization in which certain types of providers must participate in ACO, and in the form of higher service rates to incentivize other providers to participate. He said this will help achieve a fairer and more effective benchmark.

Commissioner Dr. Amol Navathe said that data analysis from MedPAC staff can help determine whether it is possible to design a benchmark repositioning and trend-based system in a voluntary program that is not affected by selection effects, although he speculates that the design of this system will have Challenging.

Some committee members expressed hesitation about jumping to the mandatory ACO model. Commissioner Lawrence Casalino (Dr. Lawrence Casalino) warned that the more compulsory the health insurance plan, the greater the financial pressure on the organizations participating in the plan, and the greater the risk that these organizations will pay less attention to quality .

“We are only talking about spending control today. But I think there is more room, and it does require more attention, to some extent-better than we are now-to measure and reward the quality of care in the organization,” he said .

MedPAC Chairman Michael Chernew stated that he did not like the idea of ??mandatory ACO and said that more should be encouraged to join the program. However, he acknowledged that although the high level of choice between voluntary programs and program participants makes setting benchmarks more complicated.

“But we certainly can’t force all groups into a strong bilateral risk model,” Chernew insisted.



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