CMS offers Advance Investment Payments to strengthen MSSP equity

Authorized by the Affordable Care Act and established in 2012, the Medicare Shared Savings Program is one of CMS’ first accountable care organization models. For the first time in MSSP’s history, the agency will offer payments upfront to encourage more providers to participate. The new Advance Investment Payments option for MSSP participants will begin with performance year 2024.

Who is eligible for Advance Investment Payments and what do they receive?

Per the CMS AIP guidance, Advance Investment Payments delivers a one-time $250,000 payment upfront to eligible providers who might not otherwise participate in value-based care. These models require substantial infrastructure investments (e.g., technology, staffing, data and analytics partners). CMS will also offer additional quarterly payments per beneficiary per quarter for the first two performance years if the ACO has met MSSP eligibility and compliance requirements.

AIP is only available for ACOs who:

• have never participated in MSSP;
• are classified as low-revenue;[1]
• are inexperienced with Medicare ACO risk-based performance models; and
• plan to apply to the MSSP BASIC Track[2].

Providers must report, publicly and annually, their planned and actual spending, and repay their AIP from any shared savings earned.

How will AIP change MSSP?

CMS wants to ensure more stakeholders can participate in VBC. The alternative, per DataGen’s Senior Director of Advanced Analytics Alyssa Dahl, would be a “class-divided” system in which providers and patients who are already underrepresented and underserved would be further excluded from an evolving healthcare landscape that seeks to deliver higher-quality, lower-cost and more patient-centered care.

Assessing the next decade of CMS value-based programs, DataGen notes that current payment models “do not reflect the full diversity of beneficiaries represented in Medicare and Medicaid” and that “CMS must drive additional provider participation and minimize selection bias.”  

AIP is the latest example of how CMS is retooling its programs to improve health equity. The ACO REACH program is another. Both programs seek to attract providers in rural and disadvantaged areas who often serve patients with more acute needs — in the areas of traditional healthcare and the social drivers of health.

“It will be interesting to see what the AIP participant profile will look like and how it will affect the MSSP profile overall,” says Dahl.

AIP addresses multiple pain points

AIP offers more funding, operational resources and added staffing to providers, alleviating hesitancy and allowing them to participate in value based models.

Financial capacity can be a make or break for providers. CMS offers MSSP participants, including AIP ACOs, a glide path — a longer timeframe to assume downside risk (financial penalties for failing to meet performance goals).

In addition, AIP money can help providers meet VBC operational challenges: a business case for participation that leaders can confidently support; a system-wide infrastructure built for alternate payments; and the data and analytics needed to create, evaluate and modify population health initiatives.

All of this requires a workforce. With AIP funding, providers can hire more staff to accomplish their MSSP goals.

Get more out of CMS value-based programs

As CMS revises innovation models like MSSP, participants must be prepared to invest their funds differently and more efficiently. A strong data analytics infrastructure helps providers identify the programs that are right for them and take advantage of new opportunities like AIP. Contact DataGen to start preparing.

[1] Per CMS, an ACO “whose total Medicare Parts A and B fee-for-service revenue of its ACO participants is less than 35 percent of the total Medicare Parts A and B fee-for-service expenditures.”

[2] The BASIC Track represents the entry level for assuming risk. BASIC levels A and B involve no financial penalties. Levels C-E include risk and reward.