Should CMS Push ACOs Into Two-Sided Risk?: Part I

July 16, 2018Garrett SchmittNo CommentsCMS, Downside Risk, MedPAC, Regulation, Risk, risk management

The Medicare Shared Savings Program (MSSP), now in its sixth full performance year, is at a significant crossroads. In creating the MSSP, Congress envisioned that Medicare accountable care organizations (ACOs) could moderate Medicare spending and improve quality of care by providers taking greater responsibility for costs and quality. While MSSP ACOs have clearly improved the…

RECORDED WEBINAR: Transitioning Into a Successful Risk-Based ACO – Part 2: How to Prepare For Risk

June 19, 2018Garrett SchmittNo CommentsACO, ACOs, APM, Downside Risk, MACRA, Reinsurance, risk management, Risk Strategies, Surety Bonds, Webinar, webinars

Download Slides  This is Part 2 of a two part series and was recorded on 6/19/2018. As with Part 1, this webinar will be informative for those considering taking risk in an ACO,  specifically Track 1 ACOs considering moving to a risk-based model in 2019. What was covered in this session: The standoff between…

RECORDED WEBINAR: Transitioning Into a Successful Risk Based ACO Part 1: Why Move to Risk & How to Protect Your ACO

June 5, 2018Garrett SchmittNo CommentsACO, ACOs, APM, Downside Risk, MACRA, Reinsurance, risk management, Risk Strategies, Surety Bonds, Webinar, webinars

Download Slides  Recorded on 6.5.18, this webinar will be informative for those considering taking risk in an ACO, specifically Track 1 ACO’s considering moving to a risk-based model in 2019. What is covered: Risk taking in the context of MACRA The move toward ACO risk: results & analysis Financial protection for your ACO View Part…

Many Medicare ACOs Would Quit Rather Than Face Risk Next Year

May 2, 2018Garrett SchmittNo CommentsDownside Risk, MSSP, MSSPs, NAACOS, Risk, risk management

Most accountable care organizations say they will disband if the CMS forces them to take on financial risk next year. ACOs that started in the Medicare Shared Savings Program (MSSP) Track 1 in either 2012 and 2013 are supposed to move to a risk-based model by their third contract periods which begin next year, according…

Building an ERM Framework for Value-Focused Health Care

April 1, 2018Garrett SchmittNo Commentsenterprise risk management, ERM, Risk, risk management

Healthcare organizations have long employed various approaches to risk management to prepare for risks that are unique to healthcare delivery settings, such as adverse events that pose harm to patients, visitors, and employees. However, with the advent of the Affordable Care Act (ACA), which mandates the tethering of clinical and financial operations together into value-based…

ACO Repayment Mechanisms – Surety Bonds

March 23, 2018Garrett SchmittNo CommentsDownside Risk, Reinsurance, risk management, Surety Bonds

Medicare Shared Savings Program (“MSSP”) Track 1+, Track 2 and Track 3 ACOs, and NextGen ACOs, have two-sided risk. CMS requires these ACOs to provide a repayment mechanism to assure that shared losses can be repaid. Depending on its track, an ACO’s repayment mechanism equals 1% or 2% of the ACO’s total per capita Medicare…

Medicaid ACOs Experiment with Social Determinant Requirements

February 15, 2018Garrett SchmittNo CommentsRisk, risk management, socail determinant

State governments are experimenting with requirements and incentives for Medicaid accountable care organizations to address social determinants of health. Government executives say Medicaid ACO programs offer several key leverage points for addressing disparities and social determinants, including partnership and care management requirements, quality metrics and financial incentives. Here are some examples of efforts under way:…

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