Next Generation Model’s Benchmark Methodology Might Empower MSSP ACOs Victory

A latest study claims that more MSSP ACOs could earn shared savings if CMS utilizes some of the Next Generation model’s benchmark methodology.

CMS should utilize an enhanced Next Generation Model’s Benchmark Methodology to calculate healthcare price thresholds to make sure that all accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) have an equal chance to earn shared savings, the authors of a research in The American Journal of Accountable Care assert.

Along with previous spending data, MSSP healthcare price benchmarks should account for regional and national spending trends such as in the Next Generation ACO model. Although, researchers discovered that the regional and national adjustments should be capped at 3.5% in the MSSP to provide ACOs a fair opportunity to succeed.

 “We also indicate, when adjusting benchmarks utilizing the adjustment methods in the Next Generation ACO model, that the connection between benchmark and saving is weakened; although, a benchmark is yet a significant determinant of saving,” researchers wrote. “We tested several levels of regional efficiency and national efficiency adjustments and evaluated that a combined adjustment cap of 3.5% best eliminates the positive relationship between benchmark and ACO performance.”

“However the Next Generation model’s benchmark methodology of ACO is effective at decreasing the correlation between prior worse performance and an ACO’s savings, the adjustment should be higher to completely eradicate the positive relationship,” researchers added.

A key challenge with earning shared savings through the MSSP, the research elaborated, is that previous healthcare spending benchmarks can make it more complex to realize savings over time. MSSP cost thresholds are evaluated utilizing healthcare spending trends from 3 years prior to the performance time as well as various adjustments for sufferer risk and the national growth amount in Medicare spending. MSSP ACOs earn shared savings if they decrease their healthcare prices within a specific percentage, ranging from 2 to 3.9%, of the developed spending threshold.

CMS recalculates benchmarks every 3 years of MSSP participation, researchers asserted. But once healthcare spending reduces through the program, benchmarks are also decreased. ACOs might find it challenging to continuously lower healthcare prices.