Not only do many inequities exist between Medicare Advantage and the Medicare Shared Savings Accountable Care Organization program, but the programs are also in direct conflict, David Introcaso, PhD, wrote for the American Journal of Managed Care.
According to Dr. Introcaso, MA conflicts with ACO programs because it serves twice as many beneficiaries as ACOs and is expected to increase from 31 to 40 percent of all Medicare enrollees in five years. Yet HHS Secretary Burwell wants to have 50 percent of fee-for-service Medicare payments tied to quality in the next three years. MA markets are also incredibly concentrated, Dr. Introcaso wrote, which makes them difficult environments for ACOs, which generally have less favorable rules, he said.
According to Dr. Introcaso, CMS should address the following six inequities between the two programs, at a minimum.
1. ACO beneficiaries are not allowed to choose, but MA enrollees can.
2. MA cost benchmarks are created on a county basis, while ACO benchmarks are set by historical utilization.
3. ACO beneficiary risk adjustment scores are fixed, MA scores are not.
4. ACO plans do not have the opportunity MA plans have to earn bonuses for quality achievement.
5. ACO programs do not provide patients with additional supplemental benefits, though MA plans can.
6. MA is considered cost neutral, whereas ACOs are meant to track Medicare savings.
Read the full viewpoint here.
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