Description: On August 8, 2018, the Centers for Medicare and Medicaid Services (CMS) released a sweeping proposed rule that, if enacted, will significantly change the Medicare Shared Savings Program (MSSP). The proposed regulation, titled “Pathways to Success,” accelerates the path for accountable care organizations (ACOs) to participate in shared risk arrangements while simultaneously softening key provisions, allowing lower revenue ACOs to participate with reduced total financial risk. In addition, CMS has proposed numerous methodological and operational changes. In this presentation we share the most important details of the proposed regulation’s key provisions and briefly discuss how they might impact the Medicare Shared Savings Plan. Furthermore, we will discuss how changes to the Medicare ACO program are likely to have ripple effects in commercial ACOs, and how actuaries are poised to help both payers and providers navigate and succeed in these complex arrangements.

Description: For years, the healthcare industry broadly and Centers for Medicare & Medicaid (CMS) specifically have been looking for ways to manage ever increasing healthcare costs without compromising quality. In an effort to achieve this goal, CMS has been considering options for shifting financial risk to providers as a way to incentivize practitioners to provide efficient, lower-cost care. The Medicare Access and CHIP Reauthorization Act, or (MACRA) is a sweeping reform designed to, change how providers are reimbursed for Medicare FFS beneficiaries and encourage providers to enter into financial risk sharing agreements for the care of their patients. Although the goal is simple, the details of the program and associated alternative payment models are quite complex. Actuaries are poised to help both payers and providers of all types manage this transfer of insurance risk and create approaches to achieve desired outcomes.