As the healthcare landscape evolves, the importance of adopting value-based care strategies in the Traditional Medicare program becomes increasingly evident. This podcast episode is going to provide you with invaluable perspectives on navigating the complexities of value-based care and making informed decisions for the future success of your organization with the MSSP and ACO REACH programs.
Joining us for this episode is Joe Satorius – an expert on advanced alternative payment models in the Medicare program. Joe serves as Senior Vice President, Operations & Enterprise Strategic Initiatives for Lumeris. In this capacity, he oversees comprehensive performance and operational functions related to population health initiatives, provider partnerships, and ACO REACH programs. Joe brings deep expertise in alternative payment models which reward health care providers for delivering high-quality and cost-efficient care and is a sought-after speaker and authority on CMMI programs.
Episode bookmarks:
01:30 “As the healthcare landscape evolves, the importance of adopting value-based care strategies in the Traditional Medicare program becomes increasingly evident.”
02:00 Introduction to Joe Satorius, as Senior Vice President, Operations & Enterprise Strategic Initiatives for Lumeris.
02:30 Coming Soon! – The next episode of EHV will feature Micky Tripathi, National Coordinator for Health Information Technology.
03:00 Link to the companion whitepaper to this podcast interview written by Joe and Eric.
04:00 “Value-based care is a “need to have” since two-sided Medicare risk is the only way to amplify upside opportunities in both clinical and financial transformation.”
05:30 Post-pandemic system-level shocks and continued provider margin deterioration.
06:00 The hyper-accelerated rate of change in the healthcare landscape.
08:00 Health system Board members need to become educated in the tenets of VBC in the Medicare program to understand why adopting financial risk is necessary.
09:00 “Readiness to take downside risk is important because two-sided risk contracts are a strategic lever for amplifying upside revenue potential.”
10:00 Joe explains why joining programs like the MSSP or ACO REACH presents a viable path forward for organizations seeking to ensure long-term solvency through care delivery transformation.
12:00 Delivering care that is both high touch and high tech – utilizing the full enablement potential of holistic, patient-centered, relationship-based models of care with technology, analytics, and AI.
13:30 Downside risk avoidance poses an unintended consequence of losing aligned providers and beneficiaries to market competition.
17:00 Assessing readiness for risk-based payment (i.e. thorough assessments of infrastructure, data analytics capabilities, and care delivery models to identify areas for improvement and development).
18:30 Enabling partnerships that can support provider organizations in accessing capital, infrastructure, technology, and expertise that inform new systems of care.
20:00 “When we are successful, the culture of an organization changes towards patient-centricity and accountable care. And trust me…this is hard work. It doesn’t happen overnight.”
21:30 Incremental pacing vs. Accelerating pacing in value-based care adoption (when is the tipping point reached?)
22:30 The “payment straddle” -i where the FFS curve and the Value curves intersect. (The key is to minimize time in the straddle between curves).
24:00 “Ultimately, the tipping point is really a function of the shift in how margin exists within the system and how you can allocate that on a fixed asset base.”
25:00 “Executives and board members should approach their evaluation of MSSP or ACO REACH with a forward-thinking mindset, considering not only the immediate financial implications but also the long-term strategic impact on their organization’s ability to deliver high-quality, patient-centered care.”
27:00 TIN/NPI-Level Segmentation – considering a bifurcation strategy in a network where specific providers can be positioned to succeed in accordance with their value-based readiness.
29:00 Joe provides a brief overview of the MSSP and ACO REACH programs and explains how a provider network can leverage the programs to create a “varsity” and “JV” structure based on performance readiness.
32:00 “It is highly advantageous to combine MSSP and ACO REACH options since, together, they offer organizations a flexible and customized approach to value-based care participation.”
34:30 The uncertainty of the Advanced APM Bonus structure and recent policy efforts to extend it.
36:00 Considering the broader strategic implications of embracing risk-based payment models and not just evaluating the APM Bonus upside in a vacuum.
39:30 “Capturing first dollar risk is the ultimate goal in a value-based Medicare strategy once an organization has developed an advanced level of sophistication in managing population health for aligned populations.”
41:30 Creating systems of care to capitalize on the enhanced risk exposure in that first dollar zone.
42:30 Evaluating the Performance Year discount in the Global option of ACO REACH.
44:30 Data-driven decision-making to select the right payment model or risk track.
46:30 Joe discusses how the flagship MSSP ACO program is a bridge to risk and a viable alternative for organizations seeking to embark on their value-based care journey.
50:00 Arbitraging on the Benchmark vs. True Care Delivery Transformation.
51:00 The CMS Application Timeline for ACO Participation in Performance Year 2025
53:00 The call-to-action to decide on program participation. (Is doing nothing an option?)
54:30 “Don’t go this alone.” – the importance of enabling partnerships to attain success for all populations via risk-sharing and total-cost-of-care models.
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