Observing the amount of spend going in and out of network for ACOs in the Medicare Shared Savings Program can provide insight and a benchmark for all types of organizations concerned with optimal network design and management.
Click here to read about observations and takeaways from this analysis on the CareJourney blog.
The dashboard allows you to view ACO spend over time, along with the percent of that spend that was in and out of the ACO network.
Use the States filter at the top of the dashboard to limit the ACOs in the scatterplot view. This top section of the dashboard displays the relationship between allowed spend and the percent of that spend that was kept in network, as well as the relationship between Part A and Part B utilization rates. Use the Year filter to alter the year of data being displayed in these two charts.
Use the ACO filter to select up to four ACOs for which to view data in more detail. The list of available ACOs will depend on the states that have been filtered for. The middle section of the dashboard displays total allowed expenditures in each year, and the percent of that spend that was kept in-network in each year for the selected ACOs. In the bottom section of the dashboard, use the Year filter to view the percent of in vs. out of network spend (overall, and broken out by Part A and Part B spend) for the selected ACOs in a specific year.
For this analysis, we consider all Medicare Part A and B spend for beneficiaries attributed to Medicare Shared Savings Program ACOs between 2014 and 2018. For each provider or facility a beneficiary visited, we reference the ACO rosters to determine whether that provider or facility was in or out of network for the beneficiary. We then calculate the percent of overall spend staying in or leaving the network each year.
Because the MSSP provider and facility rosters have only been made publicly available through 2017, we have extrapolated the 2017 roster to apply to 2018. This means that, for patients attributed to each ACO in 2018, we are determining whether their care was received in or out of network based on the 2017 definition of the ACO. Therefore, only ACOs that joined MSSP in 2017 or earlier are included in this dashboard.
If you're interested in better understanding the drivers of network utilization and the network structure of high-performing ACOs, we want to hear from you! CareJourney can help by looking deeper to identify utilization rates by spend category, facility type or specialty to assess potential areas for network optimization and utilization reduction.
If you’re part of an ACO that was new to MSSP in 2018 or later and want to see how you compare, CareJourney can ingest your network to take a closer look.
Should you have any additional questions, please reach out to your main point of contact at CareJourney for more information and/or additional support regarding this analysis. If you do not have a main point of contact at CareJourney, please reach out to jumpstart@carejourney.com.
CareJourney is a leading provider of clinically-relevant analytics for value-based networks supporting leading payer, provider, and life sciences organizations across the US. We help these organizations achieve their goals by bringing new, high value insights out of expansive population claims data.