Barriers for Using ACOs for Multipayer Contracting

By: Anne O'Hagen Karl
– Executive Insight

In the initial rules governing the Medicare Shared Savings Program (MSSP) released in 2011, the Centers for Medicare and Medicaid Services (CMS) stated that it intended for the MSSP to create a platform for multipayer value-based purchasing. Once nascent accountable care organizations (ACOs) gained experience with value-based purchasing through the MSSP, they would look to contract with commercial insurers and employer plans (and even, potentially, state Medicaid agencies). Multipayer contracting was seen as critical for the long-term success of ACOs for two reasons. First, ACOs contracting with multiple payers would spread fixed infrastructure costs over a broader patient population. Second, and more importantly, providers would create a single approach to delivering coordinated care that varies based only on the patient's needs, not the patient's payer source. Despite the initial wave of excitement over the prospect of using the MSSP ACOs across multiple payers, CMS's own rules and guidance regarding governance and participation have limited the ability of providers to use a single ACO structure to contract with multiple payers. This article describes the provisions in the MSSP rules and guidance that limit the ability of ACOs to engage in multipayer contracting.

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