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Controlling costs is a key Value-Based Care goal, a fact well-known to ACOs that share savings with CMS. Even as individual ACOs have generated tens of millions of dollars in savings, however, MSSP ACOs as a whole have only been able to reduce their Total Cost of Care (TCOC) by a fraction. That is a program vulnerability and one reason why value-based payments are increasingly incorporating population-based payment.
Plainly stated, claims data (especially 2-5 months old) isn’t a great tool for identifying patient risks, Medicare HCCs notwithstanding. The timeline for cost prevention is before events occur, not when you’re looking in the rearview mirror. Although using emergency room and inpatient admissions can help you to follow up on patients and possibly forestall future problems, you may well miss the patients who are next in queue for events but hidden from view because you can’t see the risks present in clinical data.
With Alternate Performance Pathway (APP) Reporting, ACOs can do better. Even if you’ve never collected a bit of clinical data, you have the ability to identify some of your most vulnerable patients through APP Measures. Let’s see how that can work to put you ahead of the game and boost your savings.