I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.