Managed Healthcare Executive January 24, 2022
Authors of an article in Health Affairs about a program for smaller and rural ACOs say their finding show those kinds of ACOs can generate major savings for Medicare, but apprehension about downside risk prompted an exodus from the program.
The question of whether ACOs should be forced to accept “downside risk” — in effect pay a penalty if they exceed certain spending benchmarks — has bedeviled CMS’ ACO programs and ACO programs in general. Seema Verma, the Trump administration’s CMS director, pushed for more downside risk, and the administration’s Pathway to Success program shortened the period during which ACOs in Medicare’s main ACOS could earn bonuses— “upside risk” — without also assuming the possibility of downside risk. Verma and...
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