Health Futures President Jeff Goldsmith

Value-Based Care

CMS Reports Record Performance for MSSP

CMS just released the Medicare Shared Savings Program results for 2022, and the report managed to drum up some serious debate on the effectiveness of MSSP despite last year’s record performance. 

MSSP saved Medicare $1.8B in 2022, marking the sixth consecutive year of savings and the second-highest total since the program launched in 2012.

• The program generates savings by working with accountable care organizations, or groups of providers who collaborate to cut down on avoidable utilization, duplicative care, and medical errors.

• The ACOs that effectively improve care quality and reduce total spend are then able to share in that success, and 63% of participating ACOs were compensated in 2022.

Standout performers included Aledade (four of the top ten ACOs for overall savings rates) and Privia (delivered expenditures 8% lower than the median MSSP ACO), although results were mixed for other high profile participants like CVS.

• CMS called out the fact that low-revenue ACOs comprised mostly of primary care physicians generated $294 per capita in net savings (vs. $140 per high-revenue ACO), underscoring the importance of primary care to the overall program. 

Although at first glance those numbers make 2022 one of MSSP’s best years to-date, it’s worth noting that the total cost of Medicare over that time frame was a mammoth $747B.

• That means that MSSP, the crown jewel of CMS value-based care programs that includes 482 ACOs equipped with some of the best care delivery tools in the industry, delivered an overall savings of just 0.24%.

• That’s not to say that $1.8B is anything to scoff at, but it highlights the sheer size of the task at hand, and CMS devoted a healthy portion of the press release to proposed MSSP updates that would include more people who receive care from NPs / PAs and encourage ACOs to care for more medically complex beneficiaries. 

The Takeaway

MSSP had a great 2022 by almost every metric, and the ACOs participating in the program are the tip of the spear for improving the country’s fractured health system. That said, it’s a long journey to lower overall costs even with $1.8B steps, and there’s still plenty of work to be done to help get there faster.

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The Wire

• Waystar Files for IPO: Revenue cycle management company Waystar confidentially filed for an initial public offering at a rumored $8B valuation, perhaps the best sign yet that the IPO market is finally beginning to thaw. Waystar was formed in 2017 through the merger of Navicure and ZirMed, and was last valued at $2.7B in 2019 when EQT acquired a majority stake in the company. Should the IPO take place as planned, Waystar would be the first digital health company to go public since Akili Interactive and Euda Health each took the SPAC route in 2022. 

• The Paradoxical Decline of Geriatrics: A JAMA viewpoint from UMass Memorial Health geriatrician Dr. Jerry Gurwitz called attention to the “paradoxical decline” of geriatric medicine as the overall population continues to age. The number of geriatricians in the US has fallen almost 40% over the last decade, and only 43% of geriatrics positions were filled in the 2022 fellowship match (the lowest percentage across 71 specialties). Demographic trends clearly aren’t attracting many newcomers to the field, and Dr. Gurwitz seems rightfully concerned that these trends spell trouble.

• Withings Body Scan Clearance: Withings announced the FDA clearance of its Body Scan Connected Health Station, making it the first smart scale to gain approval for the detection of atrial fibrillation through a 6-Lead ECG. Outside of the AFib detection and the obvious weight measurement, Body Scan also carries a range of other sensors to pick up unique biomarkers, such as basal metabolic rate (the number of calories the body burns at rest) and overall body composition (whole-body fat, water percentage, visceral fat, plus muscle / bone mass).

• Mouth Rinse CVD Testing: A mouth rinse test could bring cardiovascular disease risk evaluations to dentist and primary care offices, potentially creating a new early detection pathway. Researchers analyzed mouth rinse tests and ECG results from 28 healthy non-smokers, finding that participants with high levels of white blood cells in their saliva had lower flow-mediated dilation levels (6% vs. 10%). This is the latest example of efforts to bring CVD testing into new healthcare pathways, such as eye care, mammography, and even grocery aisles.

• Oak Street + Strive Health: Oak Street is joining forces with Strive Health to bring value-based kidney care to late stage CKD and end-stage renal disease patients across 21 states. If reading that gave you déjà vu, it’s because Oak Street also partnered with Interwell earlier this year to launch OakWell primary care for patients in dialysis centers. While the OakWell partnership focused on primary care for dialysis patients, the Strive collaboration is about kidney care for primary care patients, and it seems notable that Oak Street went with a second partner considering the existing relationship.

• Trilliant Open-Sources Provider Directory: Trilliant Health is opening up access to its national provider directory to any organization interested in connecting to its API and using its pre-built toolkits to develop their own resources. The directory is built on top of claims data from over 300M Americans, and Trilliant’s goal with open-sourcing the solution is to foster innovation while helping health plans and employers remain in compliance with CMS transparency regulations when they have to start publishing cost comparison info at the start of next year.

• AI Reimbursement Landscape: An article in JACR highlighted the economic barriers limiting wider adoption of AI in healthcare. The study points out how the complex nature of Medicare reimbursement puts the US at risk of falling behind other countries in the quest to implement healthcare AI on a national scale. The establishment of the NTAP program was originally thought to be a reimbursement milestone for inpatient AI solutions, but the authors note that every AI tool approved under NTAP has seen its reimbursement expire due to the three-year time constraint on the program’s approvals.

• WellSky Acquires Experience Care: WellSky acquired post-acute and long-term care company Experience Care as it looks to streamline the operational workflows of skilled nursing and assisted living facilities. Experience Care has over 150 long-term care clients using its NetSolutions EHR, and these organizations will soon be able to connect to WellSky’s network of over 2k hospitals to improve collaboration and increase visibility of patients across care settings.

• Keona Series A: Healthcare CRM startup Keona landed $7M in Series A funding to expand the reach of its CareDesk platform to more primary and specialty care practices. CareDesk is an all-in-one CRM / practice management tool that handles everything from self-scheduling to telephone triage, and Keona is targeting the solution at the private practices getting rolled into larger management services organizations by private equity to help them streamline operations as they scale.

• More GLP Heart Improvements: Weeks after Novo Nordisk’s semaglutide (Wegovy / Ozempic) was found to reduce major cardiac event risks by 20%, new data at ESC 2023 revealed that the weight loss drug also improves key heart failure quality of life metrics. Researchers gave 529 obese patients with HFpEF either semaglutide or a placebo, finding that after 52 weeks the semaglutide group had greater average improvements to their KCCQ-CSS scores (+16.6 vs. +8.7 points), 6-minute walk distance (+21.5 m vs. +1.2 m), and of course bodyweight (−13.3% vs. −2.6%).

• Prior Auth Cut Backs: A recently proposed regulation in California would prohibit health plans from requiring prior authorization if the payor approved less than 90% of prior auth requests by the provider for that type of service in the previous year. On top of that, Cigna announced that it is removing prior auth requirements for nearly 25% of its medical services (600 codes), adding to a similar move from UnitedHealthcare earlier this month.

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