The NAACOS Spring Conference 2025, held April 22-24 in Baltimore, brought together a dynamic mix of healthcare professionals, policymakers, and innovators, dedicated to shaping the future of Accountable Care Organizations (ACOs). This year’s event underscored the need for health systems to address evolving challenges and advance value-based care (VBC) to enhance care quality, improve patient outcomes, and manage costs more effectively.
Health systems are under increasing financial strain from rising costs and lower reimbursements, adding pressure to adapt quickly. Despite these challenges, leaders remain committed to delivering high-quality, sustainable care that meets patients’ evolving needs.
Following the discussions, the conference emphasized the pressing need for transformation within the healthcare sector. Throughout the week, three major themes and insights emerged, highlighting the critical areas requiring attention.
1. Strategic insights into MSSP and REACH
One of the key themes that stood out was the strategic differences in payment models. The Centers for Medicare and Medicaid Services (CMS) offers several programs designed to reward ACOs for successfully managing costs and quality for their patient populations. Among these, the Medicare Shared Savings Program (MSSP) and the ACO Realizing Equity, Access, and Community Health (REACH) models provide significant opportunities. REACH, which builds on the successful Next Generation ACO Model, replaced the Global and Professional Direct Contracting Model on January 1, 2023, and is currently set to expire at the end of 2026. It offers higher levels of risk and reward than MSSP. However, both models also come with considerable financial risk for participants.
The payment model differences aren’t just technical details—they are crucial for organizations aiming to succeed. Many found that REACH offers more favorable benchmarking years, which can be a real advantage. There was also plenty of discussion about the Accountable Care Prospective Trend (ACPT), posing challenges in MSSP but offering benefits in REACH, making it particularly appealing for ACOs with frequent NPI/TIN changes. REACH also provides flexibility, removing specific NPIs from performance calculations, helping manage specialty performance within TINs. The takeaway? Thoughtful selection and structuring of payment models can significantly shape an ACOs future, aligning with goals and maximizing benefits.
At Milliman MedInsight, we are dedicated to guiding ACOs through the complexities of healthcare models. We provide expert guidance in selecting and optimizing the right models, unlocking substantial opportunities for providers committed to efficiency and high-quality care. Milliman ACO Builder offers immediate insights into the cost, risk, and attribution not only for individual ACOs but for all Medicare providers. With this comprehensive data set, ACO leaders are empowered to make informed decisions that strategically shape the future direction of their organizations.
2. Leveraging actuarial insights for business strategy
One message resonated clearly: having actuarial expertise is no longer optional-it’s crucial for success in VBC. Throughout the event, it was clear that ACOs need to fully grasp their trend assumptions and keep a close watch on their performance. This diligence is key to meeting and exceeding their goals, helping them avoid falling short of model expectations.
The conference also highlighted the importance of timely data, such as Admission, Discharge, Transfer (ADT) feeds, which are essential for real-time insights into patient movement and risk. Access to this data allows healthcare providers to make quick, informed decisions, crucial for improving patient care and operational efficiency. Additionally, the potential for resetting MSSP benchmarks was discussed as a valuable, yet often overlooked, opportunity for organizations striving to realize savings. By leveraging these opportunities, ACOs can better align their performance with financial goals.
Organizations focusing on building strong actuarial capabilities will be better prepared to adapt and succeed as program rules and market conditions change.
Milliman stands as one of the world’s largest independent consulting firms, uniquely positioned at the crossroads of analytics, healthcare actuarial expertise, and technology and operations consulting. With healthcare as its largest practice area, Milliman is widely recognized as a leader in the U.S. healthcare consulting space. Milliman MedInsight, a product suite inspired by Milliman’s extensive consulting experience, was purpose-built to meet market needs. Since its inception in 1997 as an enterprise data warehouse and analytic reporting solution, Milliman MedInsight has evolved, establishing itself as an industry-leading provider of integrated enterprise data warehousing and analytics.
By tapping into these insights, healthcare organizations can better align their strategies with the evolving demands of VBC, ultimately leading to improved patient care and success in a rapidly changing healthcare landscape.
3. Unlocking the potential of specialists in VBC
The conference also shed light on an often-underexplored aspect of VBC: the crucial role of specialists. While primary care providers have traditionally been the focus of VBC efforts, specialists are integral to managing complex health issues and significantly impact healthcare spending. Yet, their potential in care coordination and performance improvement remains largely untapped. By integrating specialists more effectively into VBC strategies, healthcare organizations can enhance cost management and elevate the quality of care provided.
Milliman MedInsight is leading the charge in developing innovative, data-driven approaches to increase specialist participation in VBC models. By utilizing advanced analytics, Milliman MedInsight helps healthcare organizations identify how specialists can be more actively involved in care coordination, ensuring their expertise is leveraged to optimize patient outcomes and reduce costs.
As the VBC landscape continues to evolve, the role of specialists is expected to become even more pivotal. The future of healthcare will demand more inclusive and comprehensive care models, where specialists play a central role in achieving shared goals of improved outcomes and cost efficiency. Milliman MedInsight is committed to supporting healthcare organizations in this transition, providing the tools and insights needed to integrate specialists effectively into VBC strategies. By embracing this shift, healthcare systems can create a more adaptable and responsive environment that meets diverse patient needs and enhances overall care quality.
Partner with Milliman MedInsight for the future of VBC
Join us in transforming healthcare delivery with our comprehensive suite of solutions, including the VBC Platform, VBC Contracts, Milliman ACO Builder, and Milliman consulting services. Our VBC Platform streamlines operations and enhances patient-centered care through advanced analytics, while VBC Contracts align incentives with outcomes to balance risk and reward. Milliman ACO Builder provides actionable insights, identifying cost drivers and performance metrics to optimize financial and clinical outcomes. Complemented by Milliman’s consulting expertise, we offer personalized strategies to manage risk and promote sustainable growth. Discover how our integrated solutions can help your organization deliver efficient, high-quality care. Visit our website or contact us to learn more about shaping the future of healthcare together.
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