Manoeuvering the Medicare Shared Savings Program

November 18, 2015 Venkat Murthy

Many accountable care organizations (ACOs) and provider organizations seeking to take on risk-bearing contracts see the Medicare Shared Savings Program (MSSP) as a very attractive opportunity to add a potentially profitable new line of business.

On June 4, CMS released the final rule for the MSSP that will impact the current ACOs as well as those joining the program beginning January 1, 2016. Figuring out how to efficiently handle fluctuating administrative overhead that comes along with a program like this remains a major challenge with the National Association of ACOs estimating more than $1.5 million in administrative costs to run a performing MSSP.

The key requirements of MSSP that drive the most costs are: - Data integration - Data sharing - Reporting requirements - Administration overhead - Other compliance mandates

All of these requirements depend on seamless system interoperability to ensure that organizations are collecting all of the required data from all constituent systems, effectively integrating that patient, and clinical data and then making it available across the continuum of care, securely and in a timely and easy to use manner.

That is no small task, but with more than 400 ACOs currently in operation across the US, and an estimated 200 more joining the program in 2016, the stakes are higher and the competition is tougher than ever. At the same time, ACOs are facing challenges they have never had to deal with before, like assessing their overall risk profile and minimizing that risk via population health techniques with a strong focus on prevention and real-time gaps in care management.

Our client Scottsdale Health Partners (SHP), a physician-led Clinical Integration Network (CIN) and ACO with a mission to transform healthcare delivery in the greater Scottsdale, Arizona community, was struggling to face these exact challenges. In a recent conversation, Faron Thompson, CEO, Scottsdale Health Partners, discussed his frustration with the lack of workable solutions available. “ACOs are embarking in the MSSP with very basic office tools. We need to get away from using secure emails and spreadsheets, secured zip files and faxes, not one of these strategies have been effective for us.”

The good news is that many of the technical and operational challenges around administrative efficiency and population health have been solved by our MSSP Management application that can bring all systems and stakeholders together on a single web-based platform.

We have built in collaboration with SHP, an out-of-the-box MSSP Management solution that addresses all of the critical success factors for optimal MSSP performance:

  • Data integration (claims included)
  • Practice Maintenance tools in one common interface
  • Quality measure computation
  • Automated beneficiary assignment
  • Administrative data and files management

Orion Health MSSP brings a number of other significant advantages, such as:

  • Real-time and interactive dashboard highlighting compliance gaps and quality measures, empowering providers to make interventions and improve MSSP performance throughout the year
  • Robust self-service forms for data capture, eliminating the need for data exports from EMR, HIE or payer systems
  • Automatically assigns patients to participating providers per pre-set rules
  • Intuitive tools for managing file uploads, creating GPRO exports and administrative data maintenance

The MSSP Management application was designed and built in conjunction with SHP, which, in 2014, was the only Medicare Shared Savings Program in Arizona to earn a performance payment, generating a cost savings of more than $3.7 million for CMS and a shared savings of 1.8 million for SHP. Thompson sees the new Orion Health application as a critical component of potential successes for MSSP ACOs, saying that “having one system with tools that track, know the history, send alerts, include action items, and where the data is entered once, and consumed centrally, is remarkably more efficient for everyone.” We will unveil in our upcoming blogs how our innovations in MSSP management are helping our ACO customers solve critical problems.

Stay tuned for our next blog on how to drastically lower the MSSP administrative overload and get away from using error-prone and obsolete processes such as spreadsheets, faxes, and secure emails. We will show you how to easily manage users' credential, have updated user information at all times and best practices to protect patient information.

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