CMS introduces advanced payments to expand accountable care

WASHINGTON — CMS has developed policies to significantly expand access to accountable care organizations, particularly in underserved communities, as part of a larger effort to strengthen primary health care, according to a speaker here.

Accountable care organizations (ACOs) are value-based programs that focus on the quality of care rather than quantity of services.

“Primary care is foundational to accountable care,” Doug Jacobs, MD, MPH, chief transformation officer in the Center for Medicare at CMS, said during a presentation at the 2022 Primary Care Collaborative Annual Conference. “When we talk about accountable care, we’re really talking about primary care.”

There are nearly 500 ACOs serving more than 11 million Medicare beneficiaries, according to Jacobs. The Medicare Shared Savings Program is one of the largest ACOs in the United States.

Earlier this year, CMS released data that showed ACOs comprising 75% or more primary care physicians had a savings per capita of $281 compared with $149 among ACOs with fewer PCPs.

“It was almost a doubling of savings per capita in the Medicare Shared Savings Program,” Jacobs said.

However, the data also revealed disparities in access to ACOs, with Black, Hispanic, Asian/Pacific Islander and American Indian/Alaska Native beneficiaries being less likely than white beneficiaries to be enrolled in a Shared Savings Program ACO, according to CMS.

To improve access, Jacobs said that CMS introduced a new rule in which certain ACOs will be eligible to receive upfront payments to invest in provider staffing, pay for patients’ social needs — such as food and housing security — and infrastructure “to succeed in accountable care.” More payments will be allocated to ACOs that treat underserved communities, he added.

“This is one of the first times we’re forcing these payments away from typical fee-for-service,” Jacobs said.

The advanced shared savings payments will be available to certain ACOs beginning Jan. 1, 2024, according to CMS. Jacobs said the agency is exploring how to help “providers on the ground, mostly primary care doctors, take advantage of these new payments.”

CMS also introduced changes for ACOs to allow clinical psychologists and licensed social workers and counselors to provide behavioral health services as part of the primary care team, according to Jacobs. The changes relax supervision requirements so that these professionals can provide care “under general rather than direct supervision of the Medicare practitioner,” according to CMS.

“For behavioral health services, the practitioner doesn't need to be physically on site when those services are being performed,” Jacobs said.

CMS is also investigating different quality metrics, which Jacobs said “is so important because if you are being accountable for different quality metrics, how do we align all these measures so providers can focus on the most meaningful measures?”

The answer, Jacobs said, will require CMS to collaborate with providers.

“This is all part of the HHS initiative to strengthen primary care,” he said.

References:

Calendar year (CY) 2023 Medicare Physician Fee Schedule final rule — Medicare Shared Savings Program. https://www.cms.gov/files/document/mssp-fact-sheet-cy-2023-pfs-final-rule.pdf. Accessed Dec. 15, 2022.

HHS finalizes physician payment rule strengthening access to behavioral health services and whole-person care. https://www.cms.gov/newsroom/press-releases/hhs-finalizes-physician-payment-rule-strengthening-access-behavioral-health-services-and-whole. Published Nov. 1, 2022. Accessed Dec. 15, 2022.

Medicare Shared Savings Program saves Medicare more than $1.6 billion in 2021 and continues to deliver high-quality care. https://www.cms.gov/newsroom/press-releases/medicare-shared-savings-program-saves-medicare-more-16-billion-2021-and-continues-deliver-high. Published Aug. 30, 2022. Accessed Dec. 15, 2022.