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QUESTION: What is the significance of the CMS “Pathways to Success” program for ACOs in the Medicare Shared Savings Program?
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ANSWER: At the end of 2018, the Centers for Medicare & Medicaid Services (“CMS”) redesigned the Medicare Shared Savings Program. Although the Medicare Shared Savings Program had been in operation since 2012, it had failed to generate the kinds of cost savings that CMS hoped to manifest. “Pathways to Success” was intended to accelerate the process of transitioning Accountable Care Organizations (“ACOs”) to performance-based risk models.
Among other things, the Pathways to Success program implemented certain kinds of “risk tracks” that offer different mixtures of risk and reward. Each risk track balances factors such as the potential for financial rewards (in the form of shared savings), the risk of financial penalties (in the form of shared losses), and the opportunity to qualify as an Advanced Alternative Payment Model (which provides certain benefits for individuals subject to the MIPS program).
There are many different variables that govern an ACO’s performance and opportunities under the Shared Savings Program, which means that a full discussion of the program details falls well outside the scope of this article. The key takeaway to understand is that Pathways to Success was designed to accelerate ACOs to take on higher levels of financial risk and responsibility. This is yet another example of the ongoing federal effort to promote population health while simultaneously combating the growth of health care expenditures.
To learn more about the Medicare Shared Savings Program, click here.