January 10, 2019


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Caravan Health Webinar Recording Now Available 

On Friday, January 4, 2019, Caravan Health President Tim Gronniger and Policy Officer LeeAnn Hastings led a webinar to go over the details of the newly published final Medicare Shared Savings Program regulation. Nearly 600 registrants participated in the interactive event, which covered the new, faster glidepath to risk, the new shared savings rates, and the much-anticipated changes to benchmarking. The new policies all affect choices for new and continuing ACOs, including how ACOs can earn shared savings. 

Tim and LeeAnn summarized these key points in the final rule. The full webinar is available here.  


Changes to Tracks and Levels


Summary of Finalized MSSP ACO Tracks 


  • Tracks 1, 1+, 2, and 3 will be replaced by Basic and Enhanced tracks including levels of annually increasing risk; ACOs can finish out their agreement period under previous tracks before transitioning to the new system.   

  • ACO agreement periods under the new tracks will be 5 years, rather than 3.  

  • For 2019 only, ACOs can apply to start mid-year in July for a six-month first agreement year. 

  • The ACO shared savings rate in the earliest years of the Basic track will be 40 percent, lower than the 50 percent in the current track 1 but higher than the 25 percent CMS proposed in August 2018. The savings rate rises in the later years of the Basic track as ACOs take on downside risk. The Enhanced track has the highest opportunity for shared savings or losses, similar to Track 3. 

Transition to Basic and Enhanced Tracks 


Flexibility for Physician-Only and Rural Providers

  • To be considered low revenue, the ACO must have control of less than 35 percent of Medicare costs for their ACO beneficiaries.  

  • Low revenue ACOs can spend one additional year in one-sided risk, but then must move to the highest risk level of the Basic track.  

  • Low revenue ACOs can also spend two five-year agreement periods in the Basic track; high revenue ACOs are restricted to one Basic agreement period. 


Benchmarking and Risk Adjustment 

  • Benchmark calculations will include regional factors starting in year 1, instead of starting regional adjustment in the second agreement period.   

  • This earlier introduction of regional adjustment allows more accurate benchmarking for ACOs especially those ACOs with high regional penetration and lower spending growth.  

  • To account for changes in health status of ACO beneficiaries, CMS will allow a 3 percent growth in risk score over the five-year agreement period, rather than annual adjustments to the benchmark. 


Tim and LeeAnn took several questions from the audience about a wide range of issues, including prospective and retrospective beneficiary assignment, new beneficiary incentives, and participation options for those already in ACOs. There were so many questions that they couldn’t get to all of them. We will answer many of the questions in blogs in the coming weeks.  A few days after the webinar, CMS announced that the application submission period for a July 2019 start will be open from January 22 and February 19, 2019 at noon ET.

Watch the webinar now

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