Shared Savings is a payment strategy that has been implemented to change the structure of today`s healthcare system from a service pricing (FFS) model to a new value-based care model. As payment reform expert Michael Bailit explains, Shared Savings is “a kind of payment reform strategy that encourages providers to reduce health spending for a defined patient population by providing these providers with a percentage of the net savings achieved through their efforts.” The success of a value-based repayment plan, including common savings agreements, ultimately depends on the existence of an open and cooperative partnership between the provider organization and the payer. This type of partnership requires a judicious exchange of data, assumptions and expectations between the two parties. To be part of a value-based repayment agreement, a supplier organization must be able to make informed decisions about the proposed agreement, including the relevance of the financial objective, the likelihood of financial success of the organization and the financial impact of certain contractual provisions. Provide quality, coordinated care to improve results and reduce costs. This is the main objective of the Medicare Shared Savings Program (MSSP). The MSSP is an alternative payment model that rewards eligible providers, hospitals and providers to improve health for individuals, improve population health and reduce growth in health spending. Although there are several alternative payment models to reform the payment system in the health sector, the Medicare Shared Savings Program (MSSP) is cmS`s largest ACO program. Since January 2017, CMS has used the MSSP to encourage the creation of 480 COOs in 50 states, including Washington, D.C. and Puerto Rico. In the MSSP, teamwork comes first. To participate, providers must be part of an Organization for Responsible Care (ACO), a patient-centered network that shares financial and medical responsibilities to improve patient care while limiting unnecessary expenses.
The MSSP requires ACOS to promote evidence-based medicine, involve recipients, report internally on quality and cost metrics, and provide coordinated care among physicians, specialists and acute and post-acute providers. Within the ACO, everyone works together to streamline processes, reduce duplication and improve quality – and everyone participates in financial savings and the potential risks that come with them. VBR is often used by payers to encourage suppliers to take more risks over time with contracts that begin as common savings or “bottom-up” agreements and to turn to common risks or “bilateral” agreements after a few years. Providers of shared risk agreements may also be encouraged to take responsibility for increasing savings and losses over time and to continue to move along the spectrum towards global debt per capita. “Since the inception of ACOS in 2012, many have faced the limit of their risky contracts and are considering the possibility of continuing the Medicare and Medicaid Services (CMS) Common Savings Program. The pressure to take more financial risks is greater than many ACO are willing to accept. Especially with insufficient information and uncertainty about how patients are selected to enable companies to achieve their goals successfully. This concern is shared by 71% of ACOs, according to a survey by the National Association of Accountable Care Organizations, which suggests that additional financial risks would push them out of the program. Availability Assessment Part of determining the achievement of a financial goal is to determine whether your organization is ready to succeed with a value-based refund.