Value-Based Care: Humana Enters DCM, ACOs Concerned about MSSP Changes

The Centers for Medicare and Medicaid Services (CMS) is deep into Medicare alternative payment model (APM) revision and adjustment. One such program undergoing review is the Medicare Shared Savings Program (MSSP) and the revisions include major changes to quality reporting methodologies, the crux of the program.

CMS posted its final rule for the Medicare Physician Fee Schedule after many industry stakeholders expressed concerns with the modifications, according to analysis from the Healthcare Financial Management Association. Of major concern is the new requirement to report electronic clinical quality measures that involve a lot of data-aggregation steps for accountable care organization (ACOs) participants.

The National Association of ACOs (NAACOS) penned a letter to Health and Human Services Secretary Xavier Becerra, urging him to delay the mandatory reporting changes, elaborating on their specific concerns:

The new MSSP measures may be especially sensitive to differences in clinical complexity and social risk factors across patient populations. Yet, CMS has not articulated how the agency will account for these differences, which is especially problematic since the data will be collected on an all-payer basis. This policy gap means that ACOs serving sicker and more vulnerable patients may score more poorly

Health insurance giant Humana will begin contracting with healthcare providers through the Direct Contracting Model, in which the Humana Direct Contracting Entity will be called Humana Care Solutions. According to Healthcare Finance, HCS will partner with 420 care providers for participation and has pledged to support providers with clinical and analytical capabilities to improve care.

University Health in Ohio is partnering with ValueHealth to provide bundled -payment models for certain procedures at its ambulatory surgical centers in Northeast Ohio. The facilities will offer total joint replacement and may soon include other specialty surgical care like ENT and pain management, Modern Healthcare reports. From Dr. James Voos, chair of Orthopedics for UH:

We know the cost of healthcare is continuing to go up and the challenges that come with reimbursement and hospital funding. So our hospital leadership looked toward the future to see what’s the best way to continue to provide that incredibly high quality of care that we’re used to delivering in an academic healthcare system with the very high efficiency setting of ambulatory surgery centers.