OIG Highlights Top 25 Unimplemented Recommendations to Reduce Fraud, Waste, and Abuse in HHS Programs

King & Spalding

In a July 2019 Report entitled ACOs’ Strategies for Transitioning to Value-Based Care: Lessons From the Medicare Shared Savings Program the OIG shares its findings from a study conducted of 20 high-performing ACOs. Each of the ACOs was selected for the study because the ACO showed a reduction in Medicare spending while continuing to provide high quality care. The study was prompted by continued efforts to shift the Medicare reimbursement system from fee-for-service models to value based care.

OIG conducted structured onsite or telephone interviews with key officials from each of the ACOs to learn about the challenges, successes, and strategies of each organization, and analyzed supplemental documentation provided by the ACOs. Following the study, the OIG recommended the following actions to CMS to support efforts to reduce unnecessary spending and improve quality of care for patients:

1. review the impact of programmatic changes on ACOs’ ability to promote value-based care;

2. expand efforts to share information about strategies that reduce spending and improve quality among ACOs and more widely with the public;

3. adopt outcome-based measures and better align measures across programs;

4. assess and share information about ACOs’ use of the skilled nursing facility 3-day rule waiver and apply these results when making changes to the Shared Savings Program or other programs;

5. identify and share information about strategies that integrate physical and behavioral health services and address social determinants of health;

6. identify and share information about strategies that encourage patients to share behavioral health data; and

7. prioritize ACO referrals of potential fraud, waste, and abuse.

CMS concurred with each of these recommendations. A complete copy of the OIG Report can be found here.

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