We are expanding support to practices with traditional Medicare beneficiaries. When you join the Optum Provider Value Network accountable care organization (ACO), you will be able to participate in the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program.
Creating a path toward value-based care
The Medicare Shared Savings Program (MSSP) is a CMS-driven program and participation in the program is voluntary. The purpose of this program is to encourage doctors, hospitals and health care providers to come together under the ACO and move toward value-based care.
CMS developed the MSSP to help facilitate better outcomes through higher quality of care. The program focuses on delivering the right care at the right time to avoid unnecessary costs and services. It helps Medicare beneficiaries receive coordinated, high-quality care.
Joining the Provider Value Network ACO
You may have signed the Provider Value Network Participation Agreement for your commercial insurance patients. To participate in the Provider Value Network ACO MSSP, the law requires that any ACO in the MSSP use a specific governance structure. As a result, a different legal entity is needed for MSSP participation as well as a different MSSP participation agreement.
Better patient outcomes and program success
When you join the Provider Value Network ACO, the team continues to focus on core services and engages your traditional Medicare beneficiaries. This can help patients achieve better outcomes through medication therapy management (MTM) interventions.
Example return on investment
1. Shared savings not guaranteed. Potential PMPY calculated based on average performance of Imperium physician-led ACOs in 2023PY after gainshare split.
2. For demonstration purposes, this calculation only considers potential MSSP attributed lives.
3. Actual gainsharing amount will be based on attribution and other performance metrics as determined by the ACO Governing Board.
- Complete the MSSP ACO Participation Agreement
- Include practice name as it appears on your Form W-9 and your practice's Taxpayer Identification Number (TIN) on page 1
- Include the following information on page 19:
- List of providers (names, NPIs)
- Provide a copy of Form W-9
- Complete the Account Setup Form — be sure to add "_PEI" after group ID
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The Tax Identification Number (TIN) and Form W-9 you provide to Optum Pay for direct deposit enrollment must match the "Pay To" TIN that is on Account Setup Form and Form W-9 you submit to Optum.
Committing to the program
When you join the Provider Value Network ACO MSSP, there are high-level responsibilities to which you will agree by signing the participation agreement:
- Commit to the ACO’s mission to provide high-quality, cost‑efficient care.
- Be accountable for quality, overall care and cost of your Medicare beneficiaries.
- Meet applicable quality performance or reporting requirements.
- Engage in data sharing with the ACO to ensure outcomes are being met.
Key benefits
Increased savings opportunities
With no fees to participate in an Optum accountable care organization, there is only upside potential for your practice. Participating practices can earn a percentage of the shared savings generated.
Tailored practice support
Optum provides tailored, hands-on practice support to their ACO participants. We guide you step-by-step through the value-based care process and provide you with tools to succeed in the program.
Enhanced patient outcomes
Optum supports your practice in delivering high-quality care and improving patient engagement. With a focus on preventive measures and effective management of chronic conditions, you can address the needs of your patients comprehensively.
Billing and payment of services and next steps
When you perform services for your traditional Medicare beneficiaries, submit those services to CMS and receive reimbursement for service-based fees directly from CMS.
Participating in this program does not translate to any rate reduction for providers. Once you sign the Provider Value Network ACO Medicare Shared Savings Program Participation Agreement, you’ll need to provide some financial information to the Practice Extend team.
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