December 21, 2018

KANSAS CITY, Mo., December 21, 2018 – Today, the Centers for Medicare and Medicaid Services (CMS) released the final version of the “Pathways to Success” rule that was proposed back in August 2018. As expected, the final rule accelerates the path of most Medicare Shared Savings Program Accountable Care Organizations to take on risk more quickly. This final rule is, ultimately, a vote of confidence in the Shared Savings Program and supports a stable path to risk.  

“Our ACOs are prepared to forge ahead in the program under these new rules,” Caravan Health’s CEO, Lynn Barr, said. “In 2019, Caravan Health will launch the largest ACO nationwide with more than 200,000 attributed lives, as well as the first ever state-wide ACO formed in conjunction with a state hospital association. We all know that the best way to take on risk – which is required much more quickly under these new rules – is scale. More lives lead to more predictable results. No one – not the federal government and no health care provider - should be writing a check based on chance.” 

The final rule includes some positive changes from the proposal released in August. CMS increased the proposed 25 percent sharing rate in the earliest years of ACO participation to 40 percent. The proposed reduction to 25 percent would have discouraged many ACOs from joining or continuing the program. In addition, CMS added more flexibilities for low-revenue ACOs and adjusted the proposed low-revenue threshold to include ACOs with participant Medicare fee-for-service revenue of less than 35 percent of the total. CMS stated the intention was to provide more time for those ACOs, including those made up of rural providers, to prepare for risk.  

“It’s great to see this final regulation published before the end of 2018,” said Caravan Health’s President and the former deputy chief of staff at CMS, Tim Gronniger. “We’re glad to see CMS’s responsiveness to many important issues raised by Caravan Health and leading ACO participants and expect that this final rule will allow health systems to move forward in delivering on the promise of Medicare’s ACO program – namely, improving quality while managing total costs.” 

CMS has consistently stated their goal of pushing providers to take risk at every opportunity, and this final rule reflects that aim. Caravan Health ACOs stand ready to succeed under this new framework.   

Caravan Health hosted a webinar to provide clarity around the rule and answer any questions. The presentation can be viewed on-demand.

Watch the WEbinar

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