Trends in Value-Based Care: Insights from Spring 2017 ACO Events

Insights posted on 5-12-2017 by Brennan Mason

Two big events last month gave us a chance to connect with leaders of some of the largest and most innovative Accountable Care Organizations (ACOs) around the country and explore some of the challenges and opportunities they’re facing in today’s unpredictable and constantly changing healthcare environment.

The first was the NAACOS (National Association of ACOs) Spring 2017 Conference in Baltimore, where more than 650 ACO leaders gathered to explore policy insights and operational strategies to ensure their success. The second was the Annual Symposium hosted by our client Care Coordination Institute (CCI) of Greenville, SC, an organization that manages ACOs. CCI’s symposium brought together physicians and other clinical and non-clinical leaders with responsibility for navigating and transforming health care at their organizations.

Together, these two events revealed some key trends and hints at the future of value-based care. Here are a few of our key takeaways:

 1. Different CMS initiatives don’t always sync up—and that creates problems.

A lack of synchronicity between different CMS initiatives (e.g., bundled payments vs. ACO) is making it challenging for organizations to understand where they are to goal. Accurately calculating who is getting the savings is critical since CMS pays based on these calculations (and will make you pay it back if you miscalculate). Many members are part of two different CMS initiatives, so this is a common problem that is unlikely to go away. It’s more important than ever for ACOs to be able to track this data themselves and have a reliable, accurate single source of truth.

 2. Rewards numbers will go up as more ACOs move to full-risk.

Even though only 31% of ACOs received savings in 2015, it’s important to remember that less than 1% were in full-risk models at that time. Essentially, it was all upside and no downside, which motivated organizations to avoid loss rather than take risk. As more ACOs move to a full-risk model, that savings percentage is expected to go up. We’re already seeing a willingness among Medicare ACOs to join full-risk models, in part due to the way providers in the network receive MACRA credit. They’re heavily incentivized to be in advanced alternative payment models, which a full-risk ACO qualifies as.

 3. Momentum for the value-based care approach will continue.

Although there’s been plenty of uncertainty around what’s next for healthcare overall, the trend toward value-based reimbursements is one of the few areas with bi-partisan consensus. In 2015, the Senate voted 92-8 to cement value-based reimbursement as the future for Medicare, and it’s still a strategy that most agree on. And if that changes? Many of the same challenges involved with getting providers to collaborate around patient care will remain. The bottom line: No matter what lies ahead, these are issues that have to be tackled.

 4. Managing an ACO can make it feel like you’re on an island.

Many ACOs are the only organization of the type in their markets, which means the leaders often don’t have local peers to share best practices and discuss challenges with. Groups and events like NAACOS and the CCI Symposium fill a huge void in helping these leaders discover what’s working and what’s not in the broader ACO community. The opportunities for peer-to-peer networking allow participants to explore solutions and discover how others are handling similar problems—and they’ll be able to take back these new ideas and experiment in their own markets.

These events are a good reminder that while healthcare remains filled with uncertainty, one thing is clear: Value-based care, in some form, is here to stay. The sooner organizations overcome the operational barriers and challenges, the further ahead they’ll be when the dust settles.