The Institute for Accountable Care provides data and analysis derived from Medicare claims data to provide insight into national and regional spending, utilization and quality trends to inform public policy and support ACO decision making.

Analysis of the Impact of Using Spending During the COVID-19 Pandemic (2020) to Set MSSP Benchmarks

In 2020 there was substantial geographic variation in the rate of growth in Medicare spending per beneficiary due to geographic differences in the severity of the COVID pandemic, and to varying state and local policies affecting business activity. Some ACOs have expressed concern that including 2020 as a “benchmark year” for ACOs entering new agreement periods in 2022 could lower the resulting benchmarks, which would then be in place for a five-year agreement period. We calculated two sets of historical benchmarks for 142 MSSP ACOs that will enter new agreement periods in 2022. Our analysis modeled: 1) Current policy with benchmarks based on historical spending in 2018 -2020; versus 2) An alternative policy of benchmarks based on 2017 – 2019 spending trended forward to 2020. Our analysis found that 45 percent of the ACOs would benefit with higher benchmarks under the alternative policy, while 55 percent of ACOs would have higher benchmarks under current CMS policy. A more detailed summary of the analysis is available here.

Geographic Variation in Medicare Spending Per Beneficiary During the COVID-19 Pandemic

There is substantial geographic variation in the rate of growth in Medicare spending per beneficiary due to geographic differences in the severity of the COVID epidemic and state and local policies affecting business activity. The decline in health care utilization will affect future ACO benchmarks and annual update factors. We calculated the annual change in spending per ACO assignable Medicare beneficiary in 998 cities. Per-capital spending is annualized, truncated and adjusted to remove COVID-19 spending according to MSSP program rules. Look up table currently being updated. Click here to look up 2019-20 PMPY trend rates individual cities and states.

Variation in Out-Of-Network Utilization in Medicare ACOs

Effective referral management is an important ACO competency. Referring patients to affiliated ACO clinicians helps ensure clinicians have access to the patient’s most recent clinical information, facilitates timely handoffs across care teams and reduces duplicative or unnecessary services. Managing care within the ACO provider network has the potential to improve performance in both value-based and traditional fee-for-service contracts. There is substantial variation in out-of-network utilization for both primary care and specialist services. Our analysis of ACO out-of-network care for Medicare beneficiaries is available here.

Recent Trends in Medicare Telehealth Utilization

Monthly Medicare telehealth utilization peaked in April 2020 at 204 telehealth visits per 1,000 and gradually declined through November 2020. Telehealth utilization was substantially higher for high-need, high-cost beneficiaries peaking at 403 telehealth visits per 1,000 in May but has also declined over time. Across Medicare ACOs, telehealth rates ranged from few than 50 visits per 1,000 to more than 600 visits per 1,000. More detailed information is available here.

If you would like more detailed information about the analyses shown here or would like your own custom analysis please contact the Institute at [email protected]