Beyond the MSSP: Uncovering Additional Payer Contracting Opportunities

September 26, 2022

By Sean Cavanaugh, Chief Policy Officer

If your primary care practice, clinic or health center initially began the value-based care  journey by joining a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO), you may be missing out on additional payer contracting opportunities that lie beyond the MSSP. These payer contracting opportunities include Medicare Advantage, commercial health insurance plans and Medicaid.

By exploring these opportunities, your primary care organization can enhance patient care and increase revenue opportunities to achieve long-term sustainability, particularly as national trends consistently indicate that the demand for Medicare Advantage is on the rise.

The sooner you get started, the better it will be. 
Primary care organizations are choosing to explore payer contracts for a myriad of reasons. Commonly, they’re currently engaged in the MSSP and would like to extend the value-based care benefits to additional patients by increasing their payer contracting offerings.

However, those organizations are also searching for ways to amplify their revenue opportunities by participating in other payer contracts. They’re looking for additional opportunities for shared savings, care coordination fees, and quality incentives they can use to achieve long-term sustainability.

As of 2022, Aledade’s national value-based care networks across Medicare Advantage, the MSSP, commercial payers and Medicaid have saved $1.2 billion across the health care system. Organizations working with Aledade are also projected to have earned more than $167 million in shared savings payments in 2021.

Russell Warrington, Office Manager at Trinity Medical Associates, is currently participating in multiple contracts with Aledade. He stated, “Value-based care is not going away. This is the future of healthcare; this is what everybody’s going toward. The sooner you get on board with it, I think the better it’s going to be.”

Payer contracting provides real impacts for real practices. 
Warrington attributes his practice’s growth to value-based care – noting that the practice began in 2014 with only seven employees and now boasts 34.

Initially, his value-based care journey began with another ACO that solely operated within the MSSP. However, he noticed that patients were still slipping through the cracks: they weren’t having their A1c levels checked regularly, and it was an eye-opening experience for him.

Warrington joined Aledade’s ACO to make improvements for all patient populations by having access to payer contracting opportunities. Through a payer-contracting partnership with Aledade, it was easier for his practice to determine what could be done differently to provide better patient care. “It’s made a big difference in patient care. We’ve seen a lot better patient outcomes. We’re tracking people who would’ve typically slipped through the cracks who aren’t now.”

Begin your payer contracting journey. 
When your primary care organization opts to participate in additional payer contracting opportunities, you can reach more patients who can benefit from value-based care arrangements in Medicare Advantage, commercial health insurance plans and Medicaid.

In turn, there’s an increased alignment between physician care, patient health outcomes and rewards generated for overall improved outcomes. While each unique payer contracting opportunity yields its own revenue opportunities, the benefits are all-encompassing for your organization and your patients.

You can sign multiple contracts with Aledade to participate in value-based arrangements with other payers. Getting started is simple:

  • You’ll need a participation agreement and to be in-network with the insurance company that Aledade has a value-based program agreement with. To obtain this agreement, you work with the commercial payer to sign a contract to become in-network with them. If you encounter any challenges, your Aledade representative can assist you.
  • Once you are in-network with the insurance company, you can join Aledade’s ACO for that select commercial payer.
  • If you are already participating in an Aledade MSSP, you can sign multiple payer agreements with Aledade, as long as you aren’t breaching any pre-existing ACO agreements you may have with other entities.

Learn more about payer contracting today.
If your primary care organization is still feeling uncertain about participating in payer contracts with Aledade, you can gain more insight by accessing Beyond the MSSP: Uncovering Additional Payer Contracting Opportunities – available on demand to stream for free. You can also get in contact with Aledade to uncover additional payer contracting opportunities that your primary care organization may be eligible for.

Don’t leave MSSP revenues on the table.
Not in an Aledade MSSP ACO yet? It’s not too late to get started. Learn why more primary care practices, clinics and health centers than ever before are choosing to join Aledade and discover your potential revenues with us.