By: Kerry Cogan
I hope everyone is doing well, staying cool, and having a great summer so far! Can you believe we are more than halfway through the year already?
A few things to mention regarding our network performance. As you may know, there is concern for 2022. While we are seeing much more engagement from the CHCs, we are also seeing significantly increased spending for Q1’22 in our Medicare population. The impact of COVID over the last two years is affecting our ability to earn shared savings because our benchmark has been continually decreasing due to reduced volume of patient visits resulting in fewer HCC codes captured on claims. It’s crucial that we recapture at least 80% of HCC scores annually and we are only at 38%. Annual Wellness Visits (AWVs) are at 2.3% which is an improvement from 2021, but our goal as a network is 20%. All Medicare Advantage payers expect 80% AWVs and they are a great source of preventative care as well as capturing quality data and attribution for MSSP.
We are seeing a lot of movement in the industry with aggressive tactics by big MSO and ACO-type entities trying to secure FQHCs in their networks and MSSP programs. As a reminder, if your CHC is approached by another entity to join their ACO, MSSP Program, Direct Contracting Entity (DCE), Network, etc., PLEASE reach out to your CHPA team.
And now for some good news! As mentioned above, we are seeing increased engagement in CHPA activities and contracts across the CHCs. We have also revamped our monthly reports and are holding a webinar and monthly office hours on how to use the data for population health efforts at the CHCs (see the “Upcoming Events” portion of the newsletter). CMS also recently released the 2023 Physician Fee Schedule (PFS) proposed rule which has some innovative and positive changes proposed for MSSP, including:
- Adding a health equity quality adjustment increase for ACOs with high quality performance by ACOs with high underserved populations.
- Reverting to the sliding scale quality scoring approach to determine shared savings and extend incentives for reporting electronic clinical quality measures (eCQMs) through 2024.
- Providing advance shared savings payments, referred to as advance investment payments, to low revenue ACOs inexperienced with risk that serve underserved populations, including an upfront fixed payment and quarterly payments adjusted for beneficiaries’ social risk.
These proposed changes are especially important to ACOs like CHPA which are made up exclusively of safety net providers. CMS also continues to interview CHPA and CCMCN on our ability to report eCQMs to assess how and why we were able to do this. CHPA was one of 12 ACOs (out of 483) in the country that was able to do this because of the Azara data platform managed by CCMCN. As always, we are grateful for our continued partnership with CCMCN and all of you.
