28 Mar Health Care Transformation Statement Regarding the ACO Primary Care Flex Model

Statement by Jeff Micklos, Executive Director, HCTTF

The Health Care Transformation Task Force appreciates the CMS Innovation Center’s new ACO Primary Care Flex Model (Model). The Model will provide long-desired opportunities for greater investment in, and payment flexibility for, primary care offered through a Medicare Shared Savings Program Accountable Care Organization (MSSP ACO). The Model provides an important opportunity for MSSP ACOs to move away from the fee-for-service chassis, a direction desired by many.

However, the Task Force is concerned that, as designed, the Model may not achieve maximum impact. Notably, excluding high revenue MSSP ACOs from participation runs counter to the Center’s goal of advancing greater integration of specialists into ACOs. High revenue ACOs are most deeply engaged with multi-specialty practices, so this design choice may force some high revenue ACOs to drop specialists or otherwise risk departure of primary care clinicians to join low revenue MSSP ACOs. When coupled with other recent policies negatively impacting multi-specialty ACOs, excluding high revenue ACOs may result in MSSP ACO withdrawals altogether.

Even participation by low revenue ACOs will likely be hindered by the Model’s design. The requirement for immediate rebasing is a disincentive to long term program participation, as CMS has acknowledged. Similarly, the prospective attribution requirement is also a disincentive, given that 70 percent of current low revenue ACOs use retrospective attribution.

The Task Force urges the Innovation Center to allow all MSSP ACOS to participate in the Model and consider other design changes before finalizing. We believe these Model refinements would better align with the Center’s goal of having 100 percent of Medicare beneficiaries in accountable care arrangements by 2030.