Overview

Perhaps the most dramatic recent development in value-based care is the announcement by HHS Secretary Alex Azar that the Center for Medicare and Medicaid Innovation is launching “new, bold” models for value-based care. Azar is a proponent of the return of mandatory models and an emphasis on providers taking downside risk. This includes a recent HHS rule that overhauls the Medicare Shared Savings Program and pushes ACOs into two-sided risk sooner. “Without real accountability, we’re just offering bonuses on top of payments that may be too high already. That’s why we have now proposed to simplify the ACO system into two tracks, requiring them to take on risk sooner,” Mr. Azar said. Azar has also said that the administration would “revisit” mandatory models that it had previously scrapped in cardiac care and said the time had come for “exploring new and improved episode-based models in other areas, including radiation oncology.” These initiatives are in sharp contrast with the actions of Tom Price, MD, the previous HHS secretary who canceled and scaled back major mandatory bundled payment programs. And more often than not the private sector follows Medicare and Medicaid’s directions in payment reform.

Accountable care organizations (ACOs) have become a major payment and delivery reform since they were introduced as a key component of the Affordable Care Act. Currently, there are more than 1,000 ACOs covering about 33 million lives across all payers—numbers that have steadily increased over time. The ACO model continues to evolve, but it seems to be here to stay.

In late 2018, the Centers for Medicare and Medicaid Services (CMS) released its Pathways to Success rule, overhauling its largest ACO program, the Medicare Shared Savings Program (MSSP). The new rule is driving ACOs to move to risk. For many ACOs this means that they can’t stay in downside-only arrangements.

In February CMS released the list of ACOs participating in the 2019 MSSP. Hospital-led ACOs and large ACOs regardless of type have low dropout rates at the end of 2018. One of the goals of the program overhaul was to move larger organizations into downside risk contracts. An early look at new dropouts suggests the rule is not driving large ACOs out of the program, and they are therefore committed to moving to more downside risk. At the same time, physician-led ACOs have higher dropout rates than hospital-led ACOs. In particular, despite new policies favoring low-revenue ACOs, small physician-led ACOs have the highest dropout rate of all ACOs at the end of 2018.

With these dramatic developments in mind the Summit is offering a number of sessions on relevant topics such as a Keynote address by Pauline Lapin, MHS, Director of the CMMI Seamless Care Models Group, a keynote on private sector accountable care initiatives by Hoangmai H. Pham, MD, Vice President, Anthem and a major presentation on the new Health Care Payment and Learning Action Network’s (LAN) Roadmap for Driving High Performance in Alternative Payment Models. In addition the Summit will offer sessions on Creating Better Quality Measures in APMs; Social Determinants of Health into ACO/Risk Bearing Models; Lessons Learned and Best Practices in Valuebased Contracting; Enhancing the Patient Engagement and Experience in Accountable Care; Lessons Learned for Specialty APMs; Engaging Specialists in Value-based Payments through Specialty Payment Chassis Design; Methods for Managing Post Acute Care; Integrating Behavioral Health and Primary Care into Value-based Arrangements; Accountable Care Organizational Resources: NAACOS, ACLC and APG.

But there is more. ACO Summit attendees are able to attend all sessions of the collocated Bundled Payment Summit IX and MACRA Summit IV. Please see the combined Agenda-at-a-Glance on page 3 of this brochure. In combination the three events feature over 40 sessions and a faculty of over 100 national experts on accountable care, bundled payments, MACRA and its APM and MIPS components and value-based care generally.

So join us in Washington, DC to learn and debate strategies for success and best practices in the nation’s newly invigorated move to value-based care and in conjunction therewith how we can improve the quality and efficiency of care that is rendered to our patients.

— Peter N. Grant, JD, PhD, CEO, Global Health Care, LLC, March 2019

WHO SHOULD ATTEND