The following appeared in VBP News


NAACOS Offers Feedback on New Direct Contracting Options

Not surprisingly, the National Association of Accountable Care Organizations has some feedback on the Geographic Population-Based Payment Option, one of three in the Direct Contracting model proposed by the Center for Medicare and Medicaid Innovation. "NAACOS supports introducing new Alternative Payment Models that emphasize quality and accountability for total cost of care,” the group says in a letter to CMMI, but urges it “to be mindful that the option doesn’t undermine the efforts of other well-established Medicare ACO models."

  • Specifically, NAACOS asks the Centers for Medicare & Medicaid Services to "launch the Geographic PBP Option in areas with low, if any, ACO penetration."
  • As well, ACO-assigned beneficiaries should be excluded from the populations for which Geographic Direct Contracting Entities would be responsible, so as to not interfere with ACO participation."

While NAACOS "appreciates more opportunities that move Medicare away from a fee-for-service payment system," the letter says, "CMS must recognize the tremendous growth of ACOs in Medicare and the groundwork they’ve lain for future success. That work must not be disrupted."

  • Data show Medicare ACOs “limit the growth of healthcare spending,” the letter says, including an independent analysis that "showed the MSSP saved Medicare $2.7 billion between 2013 and 2016."
  • The Next-Generation ACO Model also "had savings," it adds, "reflected in the program’s first-year evaluation report, which showed 18 ACOs reduced Medicare spending by $62 million."
  • Initial analysis of second-year results show, the letter adds, the program netted at least $165 million to Medicare in 2017.
  • In 2017, MSSP ACOs subject to pay-for-performance measures earned an average quality score of 90.5%.

In a separate letter, NAACOS "expresses strong support for the Professional and Global Model Options," the organization notes, as they “build off of ACO programs and principles. "NAACOS also offers several recommendations to “improve the options."

  • Provide "necessary" fraud and abuse waivers.
  • Expand utilization management tools.
  • Ensure that claims payment is optional for Direct Contracting Entities.
  • Apply “lessons learned from existing ACO programs and Medicare Advantage” when crafting risk adjustment and benchmarking policies.

"The Direct Contracting options represent an important next step in the Innovation Center’s work on accountable care models," the group adds in the letter. "Especially if CMS adopts the recommendations, the options can improve Medicare’s work to advance value-based care." NAACOS represents 330 MSSP, Next-Generation and commercial ACOs.