NAACOS Calls For Renewed HHS Focus, Funding on Value-Based Care

In a letter to HHS, the National Association of Accountable Care Organizations (NAACOS) recommended that the agency promote significant ACO growth after several years of policies have hampered healthcare’s move toward value-based care.

The letter, written by President and CEO of NAACOS, Clif Gaus, ScD, outlined the cost-saving impact ACOs have had on Medicare spending and urged new HHS secretary, Xavier Becerra, to drive ACO growth.

“Since 2012, ACOs, including those in the Medicare Shared Savings Program, Next Generation ACO Model, and the now expired Pioneer ACO Model, have lowered Medicare spending by $8.5 billion and $2.5 billion after accounting for shared saving and loss payments and discounts to CMS,” Gaus said in a press release.

“This doesn’t include ‘spillover’ effects to Medicare Advantage or commercial insurance, which also measure in the billions of dollars annually. When compounded, these savings make an undeniable impression on our nation’s out-of-control health spending.”

In the letter, NAACOS encouraged HHS to set a national goal for the majority of traditional Medicare beneficiaries in an ACO by 2025. NAACOS also called for stronger incentives that would attract new ACOs and retain existing ones.

“We request that HHS and CMS reverse certain policies from a 2018 MSSP overhaul, which CMS called the ACO ‘Pathways to Success,’” Gaus wrote. “That overhaul included some damaging provisions such as a cut to the share of savings most ACOs are eligible to keep and a push for ACOs to assume risk too quickly. These policies have chilled ACO growth and should be changed.”

NAACOS also called for HHS to ensure the transition to value-based care is provider-centered.

In 2018, CMS released a payment model first titled "Direct Provider Contracting." Later, the agency dropped the word “provider,” NAACOS pointed out. Instead of promoting the model to those who had been at the forefront of the value-based care transition for years, the payment model emphasized bringing new participants, such as payers, into Medicare at the cost of providers.

“Secretary Becerra inherits an HHS with fewer ACOs than the Obama administration left at the start of 2017,” Gaus wrote. “Reversing this trend should be a priority for him and his staff given the success ACOs have shown in reducing Medicare spending while improving quality and patient satisfaction.”

The largest and most successful value-based payment model, the Medicare Shared Savings Program, currently has 477 participating ACOs, down from a high of 561 in 2018.

What’s more, there are fewer ACOs now than there were in 2017 during the Trump administration’s first year in office. At that time, 480 organizations participated in MSSP.

However, even though the number of ACOs has gone down, the MSSP has continuously produced greater savings every year.

Gaus noted that the MSSP’s best year was in 2019, the most recent year for which data is available. The alternative payment model served over 11 million seniors in 2019 and saved Medicare $2.6 billion. After accounting for shared savings bonuses and collecting shared loss payments, the net program savings were $1.2 billion.

To grow alternative payment models, the letter calls for expanded advanced payments and grants to allow providers the infrastructure needed to spur innovation and value.

In terms of policy adjustments that will aid the push towards cost-effective, high-quality care, NAACOS called for improvements to the MSSP such as increasing ACO shared savings rates, fixing key benchmarking and risk stratification problems, granting more time before requiring risk, and revisiting recently finalized policies regarding quality.

Additionally, NAACO encouraged HHS to provide more timely and complete data to ACOs, adapt alternative payment model processes to account for COVID-19 anomalies, and address the overlap of competing payment models to focus on total cost of care arrangements.