MSSP vs ACO REACH: A Comparison of Standards and Goals

Tracing the History of CMS’ Healthcare Programs 

In the hopes of improving quality and lowering overall healthcare costs, the Centers for Medicare and Medicaid Services (CMS) designs the MSSP to test a new approach to Medicare payment. The idea of the MSSP is that provider groups, or ACOs, must receive rewards when they keep spending under a set limit and penalize them when they exceed it. It’s a different way of paying providers than what many know, as organizations are moving away from the fee-for-service arrangement. Now, each physician gets a flat rate per patient, and they have to work together with other providers in the network to keep their patients healthy and reduce costs. This way, patients can have the care they need and providers can earn the right payment for the work they do.

MSSP vs ACO REACH: What One Offers the Other One Doesn’t

The ACO REACH program is an alternative to MSSP that is available to eligible physician practices and certain non-physician providers. As part of MSSP, ACO REACH intends to promote better coordination and care for Medicare beneficiaries. However, the ACO REACH program is not the same as the MSSP. MSSP vs ACO REACH have different standards and different goals, including the following:

Health equity plans

While MSSP employs risk scoring to establish standards that, depending on their scores, can help them earn higher savings, ACO REACH builds its own health equity plan and collects key demographic and determinants of health data for its aligned beneficiaries.

Payment method

Whereas MSSP uses the tried-and-true FFS payment model, ACO REACH provides more advanced alternative payment arrangements, such as capitation and preferred provider arrangements, and includes additional benefit enhancement.

Program structure

MSSPs also have more flexibility in how they structure their programs and how they provide care. For example, MSSPs can choose to focus on preventive care, chronic disease management, or both. ACOs, on the other hand, are required to provide care for all Medicare beneficiaries, and they must meet certain quality standards set by CMS.

The Case for Utilizing Healthcare Technology as a Support Solution

The comparison of MSSP vs ACO REACH has always been one of the most talk-about programs in the healthcare industry. With CMS’s goal to make healthcare more sustainable, they are continuing to push initiatives like these. As a value-based care solutions provider, MedVision has been continuously keeping up with industry leaders like CMS. Driven by our goal to help ACOs in their processes, we develop infrastructure and technology solutions for healthcare organizations like yours to support you in managing business operations, simplifying complex workflows, and increasing your bottom line through a systematic approach that automates mundane day-to-day tasks.

It's time to change the way you do your business.