We got 𝐀𝐍 update, but not 𝐓𝐇𝐄 update from CMS on the ACPT! Do you guys remember the public health emergency (PHE)? During the PHE, COVID claims are excluded from an ACO's expenditure. The PHE ended in May 2023, so for January through May 2023 COVID expenditures were removed but were included for June through December 2023. In 2024 ACOs are responsible for all COVID claims. Actual trend from 2023 to 2024 is going to be artificially high because in addition to the typical increase in unit cost and utilization ACO are also responsible for covering a service that was not fully covered the previous year. Here is a quick example: 2023 Expenditures partial COVID = 10,000 2023 Expenditures all COVID = 10,130 2024 Expenditures all COVID = 10,500 2023 partial COVID to 2024 full COVID = 5.0% 2023 full COVID to 2024 full COVID = 3.7% CMS originally developed the ACPT using the modified USPCC, with no adjustment for COVID, so this trend was too low (as Stephen Gates pointed out last year - https://lnkd.in/enYdMqJ4). CMS is correcting this by adjusting the USPCC estimate to account for the periods when ACOs were not responsible for COVID expenditures. After the recalculation, the PY 2024 ACPT growth rate increased from 3.6 percent to 4.9 percent for aged/disabled beneficiaries and from 3.9 percent to 5.1 percent for End Stage Renal Disease (ESRD) beneficiaries. That is a pretty big help (1.3% * 1/3 blend = 0.4%) increase to the trend for the aged/disabled population. Still no word on if or how CMS will adjust for higher than expected trend for 2024. CMS memo - https://lnkd.in/ecJCTFSz
Population Health | Analytics | Value-Based Care
1wPHE was inferesting to say the least, especially for those of us working Medicaid.