After a Decade-Plus of Operating, Some Aspects of The Medicare Shared Savings Program Are Being Teed Up For Modernization
In mid-December, an impressive cadre of bipartisan United States Senators introduced the Value in Healthcare Act. While this is a companion bill to the measure introduced in the House last July, the fact that both chambers now have bills aiming to update the Medicare Shared Savings Program (MSSP) is significant.
Of particular note, is that both pieces of legislation contain a provision creating a voluntary full risk track inside of MSSP, codifying that option inside of traditional Medicare. It’s this provision I want to brief you on today.
Why Is This Important?
Up until now, most full risk options for healthcare providers were either housed in a Center for Medicare and Medicaid Innovation (CMMI) model or connected to a provider’s ability to sub-delegate risk by contracting with a Medicare Advantage health plan. There are, however, two major catch 22s in each of these scenarios.
- All CMMI models, by definition, eventually end.
- Medicare Advantage health plans, by being in the position of choosing the providers with which they contract, get to act as a sort of gatekeeper for providers who may want to take on full-risk. This potentially new full-risk option, located in Section 2(c) of the bill, would move the choice of whether or not to take on risk away from multiple decision makers and place it solely with providers. An added bonus is that it would offer the certainty of a permanent, full risk Medicare program. Of course, various insurers, hospitals and Federally Qualified Health Centers (FQHCs) have also set up their own Accountable Care Organizations (ACOs) and so this may be of interest as well.
What’s Really Going On Here?
As CMS moves full steam ahead with its goal of having as many Medicare beneficiaries as possible in an accountable or value-based arrangement by 2030, substantial private sector investment has followed into this space. It’s no secret there is also, to varying degrees, political instability surrounding CMMI and, even more specifically, some of its models. By codifying a full risk track inside of MSSP, healthcare organizations can achieve operational certainty their investments in standing up a full risk structure will be stable.
What’s The Outlook
Congress comes back to work after the holiday break next week but there’s good reason to believe an early 2024 healthcare package could pass both chambers of Congress. Here’s four ways I see it:
- Since the House already passed the Lower Costs More Transparency Act (an interesting provision of which we previously covered here) pressure for the Senate to act will increase.
- Since the Senate has been working on versions of the House-passed bill mentioned above, the likelihood of a healthcare package moving through all of Congress in the first quarter or first half is quite possible. There is also bipartisan desire in Congress to reverse pay cuts contained in the most recent Physician Fee Schedule and that could put additional pressure for a healthcare package to move and create an opportunity for other health-related measures to ride along with it.
- Related to numbers one and two, it is equally possible the Value in Healthcare Act containing this full risk provision could hitch a ride on that other, larger piece of legislation.
- Even more so, there is an impressive list of organizations supporting the Value in Healthcare Act which you can see towards the end of this press release. Support like this can ease the potential for passage.
All of these, when combined with the bipartisan nature of the bill’s sponsors, bode well for action in early 2024.