Melissa Jackson, a senior associate director in policy at the American Hospital Association, says providers need to be able to achieve greater gain-sharing if CMS wants its Medicare ACO programs to expand in the future. "We have pushed CMS to increase the amount of benefits ACOs are able to achieve," she said. "[Providers] have to make significant financial investments on the front end to improve care… The target thresholds need some adjustment."
Akin Demehin, who also serves as a senior associate director in policy at the AHA, says the proposed changes to MSSP quality standards are welcomed "in general" but need to be crafted carefully.
"The challenge is making sure those measures are adjusted for things that are out of the control of the provider," he says, adding that MSSP quality measures need to account for fundamental differences between patients such as severity of illness and socio-economic factors. "For most outcomes measures, performance is driven not just by care but also by clinical conditions."
As he looks to the future, Nasser says MSSP ACOs such as Crystal Run will eventually hit a gain-sharing ceiling.
"Accountable care is definitely here to stay because CMS is moving to value-based care delivery," he said. "But you can't continue to share savings forever. … We think over the long-term this will move to something more like Medicare Advantage and capitation."