During the pandemic, many Medicare ACOs experienced challenges related to the cost of operations, low in-person visits, adjusting to telemedicine, and many other occurrences that impacted general operations and care management. Despite these challenges, Medicare Shared Savings Program (MSSP) showed a significant increase in its total savings. MSSP, one of the largest initiatives for the Alternative Payment Model (APM), had a total savings of $4.1 billion in 2020 compared to $2.6 billion in 2019. While savings increased, it is highly recommended that ACOs take a deeper look at their ACO benchmark, a major component that can work against MSSP total savings. With the ACO benchmarks influenced by risk adjustment scores, understanding the results of your risk scores, alongside the long-term uncertainty of COVID-19, is important for an ACOs continued success in MSSP.
To address this concern, Apixio has created a simple three-step guide for Medicare ACOs seeking to effectively manage their risk score so they can continue to see success in their total savings.
Step 1: Understanding Your Risk Score
CMS recently shared MSSP 2019 and 2020 performance data for both high and low revenue ACOs and it can be observed that in all four risk categories, percent change in risk score was minimal; on average, there was a 0.39% for high revenue and 0.30% for low revenue.
MSSP PY 2019 and PY 2020 Performance Data (Risk Score % change)1
| Change in Risk Score % PY 2019 vs. 2020 | Aged Non-Dual (AGND) | End-Stage Renal Disease (ESRD) | Aged Dual (AGDU) | Disabled (DIS) | Overall Average Increase |
| High Revenue ACO | 0.38% | 0.65% | 0.21% | 0.31% | 0.39% |
| Low Revenue ACO | 0.80% | 0.55% | -0.39% | 0.25% | 0.30% |
1https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/program-data
With the risk score cap at 3%, there is an opportunity to focus on the upside benefits for ACOs to get a more complete picture of their member risk profile. However, if changes are not made, the downside risk has no cap or cut-off point and can negatively impact the benchmark, which will impact total savings.
To make the improvements needed, organizations must utilize the right solution.
Step 2: Utilizing a solution that gets to the root of your risk score
Small changes in risk scores can significantly impact total savings by way of the ACO benchmark; thus, your ACOs must utilize a solution that will accurately capture your member’s complete risk profile. By leveraging Apixio’s AI-powered risk adjustment solution, HCC Complete, which focuses on aged non-dual population (AGND) for risk, ACOs have a higher potential to see lifts in their risk score and improve total savings for MSSP.
By using industry-leading AI algorithms to power risk adjustment chart reviews, Apixio’s HCC Complete identifies both missed coding opportunities and also unsupported known codes.
In a recent client study that included 280k+ charts from providers operating in 10 states across the country, our award-winning solution:
- Increased coding accuracy by 20%
- Recovered 94% of inappropriate (false) coder rejections
- Reduced time and effort to code charts by 80%
With Apixio’s Best in KLAS risk adjustment solutions, your team will have a solution that will get to the root of your risk score stagnation or, worse, decline.
Step 3: Contact us to learn more
Contact us today to learn about Apixio’s HCC Complete solution – a solution that can capture the data to help increase your ACO risk scores and ultimately improve your total savings for MSSP.