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Part 2: Uncovering the Complexity: Variations Persist in Healthcare MSSP Expenditures

Updated: Oct 20, 2023

Unlocking the Power of Informed Decision-Making Across the Care Continuum

 

Easy access to care settings across the continuum can create habitual patterns of care for patients and healthcare providers. The decisions surrounding patient admissions and post-acute care can sometimes turn into ingrained habits due to various factors, such as streamlined paperwork processes, acceptance rates, financial considerations, accessibility, assessments, electronic medical records, and more. While each care level has unique capabilities to offer the best possible care for each patient, there's still a notable variation in expenditures across the nation.


The data underscores that even within the MSSP ACOs, there's a significant disparity in the utilization of different care levels across different states. This complexity stems from a care team-based approach, which encompasses numerous assessments and considerations.

But here's the challenge: Are healthcare providers and team members well-versed in the array of services and care settings beyond their familiar environments? It's evident that knowledge gaps exist, reinforcing habitual transition patterns, where comfort with the known prevails.


So, what's the call to action? ACOs must champion education, foster a culture of change, and collaborate closely with the entire care team to ensure patients receive the most suitable care setting. In a landscape where variations persist, ACOs have a significant role in advocating for the "Right Setting, Right Care, at the Right Time."


To illustrate the diversity across states, let's consider the 263 MSSP ACOs operating in a single state and their 2022 expenditures across four care settings. Variation becomes evident. The Northeast invests more in SNF settings, while the South and West favor home health services. Inpatient rehab expenditures are notably higher in Southern states.

Furthermore, the top five states with average expenditures above $2,000 per capita across these four care settings are California, New York, Oklahoma, Texas, and Connecticut. On the flip side, the states with the top savings rates for MSSP are Nebraska, Colorado, Nevada, Mississippi, and Louisiana. These findings indicate the dynamic landscape of healthcare expenditures.


The remaining 218 ACOs, with beneficiaries across multiple states, witness variations in utilization and expenditures. New innovations in at-home care and remote monitoring are poised to reshape the care landscape. Will inpatient rehab continue to grow? How will SNF waivers and inpatient rehab admissions influence the balance between higher acuity admits and inpatient hospitalizations? These are the questions that lie at the intersection of our opportunity and challenge.


Let's take action, empower informed decisions, and ensure that the evolving care continuum serves the best interests of patients across the nation. 🌍💼 #HealthcareInnovation #CareContinuum #PatientCentricCare #MedicareSharedSavings #ValueBasedCare


 

Average Expenditure Proportion by State

MSSP 2022 expenditure utilization by state
2022 MSSP Performance Results - PUF

Figure 1 – Purple Heat Map: 4 setting average least to greatest

Average Expenditure by State

2022 MSSP Post-Acute Expenditures by State
2022 MSSP Performance Results PUF

Figure 2 – Grey Heat Map: MSSP Savings Rate least to greatest



MSSP Savings Rate Compared to Setting of Care Expenditures


Figure 3


Proportion of Expenditures for Multi-State ACOs

Figure 4

 


Will care variation across the nation still be as prominent in 2030?

  • Yes

  • No

  • Complex Answer and Not Black and White





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