CMS Overhauls MSSP: MaineHealth ACO to Remain in Upside Risk Track Through 2020

February 14, 2019

This month, the MaineHealth ACO plans to apply to renew its participation in the Medicare Shared Savings Program (MSSP), an important value-based initiative.

2019 is a unique year for MSSP. The Centers for Medicare and Medicaid Services (CMS) have overhauled the program, making sweeping changes that are meant to accelerate most ACO's transition to downside risk. For the MaineHealth ACO, however, no substantive changes will occur until 2021. Some of the logistics of the agreement will change in the short term, but it will remain upside-risk-only for the next eighteen months.

"Though we had intended to bifurcate our network (moving MaineHealth to a downside risk track and forming a new corporation for private practices to remain in an upside track), the new framework allows for the entire network to remain together in an upside environment," says Jen Moore, chief operating officer of the ACO. "This provides additional time to prepare for downside risk and serve the Medicare population in a more integrated fashion."

Immediate logistical changes include: 

  • Extension of our current MSSP agreement to June 30, 2019
  • A new MSSP agreement will begin July 1, 2019
  • New agreement length will be five years. Previous agreement period was three years.
  • Current payment tracks will be replaced by two new tracks: BASIC and ENHANCED. The BASIC track is subdivided into levels A through E based upon level and nature of risk. We are applying for a Basic Track, Level B agreement which is similar to our current agreement. 

The new agreement will retain several important elements of the current agreement:

  • Practices will retain their participation in the MIPS Alternative Payment Model. As in 2018, they will need to submit information for the Promoting Interoperability component of the Quality Payment Program and actively participate in annual MSSP quality reporting.
  • The new agreement remains upside-risk-only through December 2020. Opportunity for the ACO to assume downside begins in 2021. As 2021 approaches, we will work closely with private practices to assess readiness for downside risk and determine an alternative path if advisable.

For general information about the changes to MSSP, please read CMS’s MSSP Fact Sheet published in December. For specific questions about the ACO and MSSP, please email Sandi Daigle, provider network manager, or call her at (207) 482-7067.

For general questions about the Medicare Shared Savings Program, contact Medicare at 1-800-MEDICARE (1- 800-486-2048). Teletypewriter users should call 1-877-486-2048.

To reach the MaineHealth ACO, call (207) 771-2004.