Accepting Downside Risk in the Medicare Shared Savings Program

May 11, 2018

The MaineHealth Accountable Care Organization is pleased to announce a major decision regarding our future direction, the evolution of our provider network and our deepening commitment to value based healthcare. 

For many months, our staff, leaders, board and owners have been carefully considering the opportunity to move to a downside risk track of the Medicare Shared Savings Program (MSSP), the value-based Medicare contracting model that inspired the creation of Accountable Care Organizations (ACOs) around the country. 

The MaineHealth ACO’s history with MSSP goes back six years, when we first entered into Track 1, an upside-risk-only MSSP contract that generates shared savings when certain cost, quality and utilization targets are hit. Track 1, which the ACO continues in today, does not assess a financial penalty when those targets are missed. The new MSSP track under consideration, Track 1.5, is an Advanced Alternative Payment Model and includes what is known as downside risk. It offers the same opportunity to earn shared savings as in Track 1 when targets are hit, and includes a financial penalty if targets are missed.  

Thoughtful, in-depth analysis of our MSSP participants’ readiness for downside risk gives us confidence that a sizable cohort is well positioned to succeed in a downside risk environment. Specifically, this cohort includes providers employed by MaineHealth and by York Hospital who are supported by robust population health, quality improvement, data analysis and administrative resources. We’re pleased to announce that providers employed by MaineHealth and York Hospital will be shifting to MSSP Track 1.5 in January, 2019, pending Medicare approval. 

All other current MaineHealth ACO MSSP participants will continue in Track 1 by entering into a new three-year MSSP agreement in January. To comply with CMS guidelines, the ACO will establish a new subsidiary corporation to host that agreement. We anticipate that Track 1 participants will feel no practical impact from this structural change. They will receive the same benefits of participation and support from the ACO that they’ve come to expect over the previous six years. 

“Our time is now,” says Dr. Betsy Johnson, president and CEO of the MaineHealth ACO. “I’m thrilled that we can offer an innovative MSSP contracting solution that meets all our participants where they are. Track 1 will remain available to those who continue to benefit from it. And Track 1.5 will offer new opportunities to practices that have the infrastructure and scale to accept a higher level of risk. I know we’re up to the challenge and look forward to partnering with all of you on this next endeavor.”

Those who would like to learn more are welcome to view a recording of our recent webinar: The ACO’s Medicare Risk Decision: What it Means to You. 

To receive ongoing updates about the decision and tips for how to succeed in the Track 1.5 downside risk environment, please subscribe to and read the monthly ACO eNews. 

For general questions or additional information about Accountable Care Organizations, please visit http://www.medicare.gov/acos.html or call 1-800 MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.