Issue link: https://beckershealthcare.uberflip.com/i/961245
49 CFO / FINANCE MSSP tracks have varying levels of risk, participation For the organizations confronting this com- plex decision in 2019, the alternative to tak- ing on risk means forgoing participation altogether, including the opportunity to qualify for MACRA's APM track or MIPS- APM reporting advantages. If an ACO leaves the program, their individual participants will have to do quality reporting on their own for the first time in six years, which would be incredibly disruptive for some sys- tems, particularly those with hundreds of participating organizations. is alone could be the motivation you need to get risk-ad- verse stakeholders on board. 4. Capitalize on remaining time in up- side only to improve risk readiness Regardless of which downside model an ACO selects, all organizations should consider these no regrets ways to prepare for downside risk in the time they have le in Track 1: • Improve coding and documentation to ensure accurate risk adjustment. Ad- dress risk adjustment gaps now so pa- tients' costs are attributed to the right benchmark category (e.g. ESRD, dual-el- igible) and future performance targets ac- curately reflect the case mix and severity of the population you serve (e.g. does your patient have diabetes without complica- tions or do they have diabetes with acute or chronic complications?). • Minimize churn to stabilize cost tar- gets. Use annual wellness visits and care management resources to ensure the pa- tients included in the benchmark calcula- tion are the same patients seen during the performance period. This is particularly critical to focus on this year since Tracks 1+ and Track 3 utilize a prospective attri- bution methodology. It's also important to ramp up efforts to reduce network leakage by solidifying patient loyalty to ACO pro- viders, which yields returns through fee- for-service revenue and shared savings. • Reevaluate who is in your network. Most ACOs realize there are certain providers they are comfortable having in network for an upside only contract, but may want to exclude when there are millions of dollars in potential losses on the line. Use the first months of this year to ensure every partici- pant in your ACO shares a commitment to the ACO's success (and will help bear the cost in the event of failure). • Adopt successful strategies used by other ACOs. Post-acute care spend reduction ef- forts were critical to the success of ACOs in 2016 and should remain a key focus (organi- zations that earned shared savings payments reduced SNF spending by 18% and home health by 10%). Emergency department di- version, readmission reduction initiatives, education regarding unnecessary imaging and monitoring of Part B drug expenditures should all remain areas of renewed focus in 2018. n Hunter Sinclair is a Vice President and Rebecca Nolan a Senior Analyst of Consulting at Advisory Board. [W]ith only 31 percent of total ACOs achieving significant enough savings to earn a bonus payment in 2016, success is still far from guaranteed.