PC Flex ACO Town Hall: Incorporating the new Flex model into your PY25 MSSP decisions

With the announcement of the new PC Flex model available to MSSP ACOs effective for the upcoming performance year, you now have even more considerations to take into account. These decisions are in addition to the big ones facing ACOs related to regulatory changes with MPFS23-24.


Understand cash flows: Calculating upside potential and downside risk exposure of adding Flex

  • Payment types: Understanding Flex payment types: ASSP, PPCP-CBR, and PPCP-EA
  • Settlement calcs: Running through MSSP+Flex shared savings calculation examples
    • Learning from the REACH payments and capitation methodology
    • What-if analysis for participant expenditure amount in relation to region
    • Risk of annual changes to the PPCP calculations across the agreement period
  • Interest rate considerations: Calculating net present value (NPV) of future cash flows in a high interest rate economic environment, including upfront payments and claims lag
  • Contract value: Quantifying the underlying long term contract value, depending on scarcity (implied by the 130 ACO limit) and regulatory risk (of CMMI eliminating new Flex cohorts after PY25)

Qualify & Optimize: ACO bifurcation and attribution strategy

  • Low revenue: Sculpting a low revenue ACOs based on participant revenue contribution
  • Financial advantage: Identifying participants who are financially advantaged under Flex
  • Early renewal: Identifying participants that benefit from early renewal in PY25 (aka re-entering ACOs) into MPFS23-24 rules
  • Panel size & composition: Panel right sizing with considerations for sufficient revenue vs maintaining quality and attribution management strategy
  • Distribution & incentives: Methodology for distributing Flex payments to participants vs MSSP shared savings settlement

Decision Logistics: Timing and keeping options open with related annual MSSP decisions for PY25

  • Strategic timing: Leaving your options open while accommodating the deadlines by applying for multiple programs or tracks until financially binding
  • Comparisons: Comparing Flex to other models and options: REACH, MCP, AIP, PCF, CPC+
  • Calendar: Suggested 6-month calendar of decisions (Apr-Sep 2024)

Q&A and Open Discussion

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