CPC+ Practices Have the Vantage Point in MSSP ACOs

June 17, 2021

Earn More Rewards for Doing the Same Work

Your practice is different today than last year. You have adapted and conquered the odds amidst unprecedented times and overcome persistent challenges to transform your method of care delivery. This commitment has required continual investments in care managers, electronic health record (EHR) technology, and new operational capabilities and processes. By design, your practice is an advanced primary care practice uniquely positioned to succeed in value-based care contracting. 

Your practice is now at a crossroad. 
The CPC+ model sunsets at the end of this year for all practices regardless of cohort or track. The end of CPC+ will significantly decrease your revenue and ability to support staff, technology improvements, and ultimately, may impact your ability to be an effective population health manager. 

  • If your CPC+ practice was not in an ACO: You were considered an Advanced Alternative Payment Model (AAPM). This status allowed eligible clinicians at your practice to receive a five percent bonus payment based on Medicare billing and excluded them from having to report through Merit-based Incentive Payment System (MIPS). 
  • If your CPC+ practice was in an ACO: Your AAPM status was based on whether your ACO was taking risk or not. For performance year 2022, CPC+ practices will have to report MIPS and lose out on the five percent AAPM bonus payment unless they join another AAPM such as the Basic E or Enhanced tracks of the Medicare Shared Savings Program (MSSP) or Primary Care First (PCF). 

4 reasons CPC+ practices are uniquely positioned to succeed in an ACO 

  • CPC+ practices have built infrastructures to achieve success in population health management and value-based care. 
  • ACOs offer strength in numbers, perfectly align with CPC+ goals, and offer the opportunity to achieve substantial shared savings. 
  • ACOs can offset the expected revenue decrease from the CPC+ model. 
  • ACOs acknowledge excellence in advanced primary care and population health and offer a roadmap for succeeding in value-based care.

In essence, CPC+ practices have transformed so they could successfully participate in an ACO. CPC+ practices not in an ACO should seriously consider joining an MSSP ACO this year.  

Is your practice in an ACO that generates results?
In 2018, the Centers for Medicare and Medicaid Services (CMS) overhauled the MSSP program with the introduction of Pathways to Success. Implemented in 2019, this program offers more ACO participation options for a faster transition to performance-based risk and to increased savings. If your current ACO is not generating results, you may want to join an ACO that can position your practice more favorably in the MSSP under the Pathways to Success program. Remember: Not all ACOs are created equal, and the status quo is not a viable strategy for maximizing your CPC+ investment.

Earn more financial rewards for same work
What your practice built in CPC+ can now be leveraged for success in an MSSP ACO. Table 1 shows CPC+ requirements that align with MSSP ACO requirements.

Table 1. Comparison of Key CPC+ and MSSP ACO Criteria

* MSSP quality description is for performance year 2022, based on the changes in the CY 2021 finalized physician fee schedule rule.

How to select an ACO partner for your practice
Making the decision to join an ACO is the first step to sustain and maximize your CPC+ investments. The American Medical Association suggests providers carefully examine all clinical, operational, and financial factors such as the ACO’s: 

  • History with shared savings or losses
  • Long-term strategy for managing risk
  • Governance options (opportunities to participate on board and committees)
  • Practice-level control over decision-making 
  • Transparency
  • Clinical outcomes and quality reporting expectations
  • Access to data-driven insights and reporting 

A good partner will be upfront about each of these items to ensure all participants are fully informed and equipped to succeed. Access Aledade’s white paper, Key Considerations for Evaluating an ACO Partner, for more information.

Learn more 
For more information on joining an Aledade ACO, contact info@aledade.com or read what our ACO partners have to say about their Aledade experience in the KLAS Research ACO Enablement Services report, April 2021

Join an Aledade ACO today! Contact Aledade at info@aledade.com for more information.