The Center for Medicare & Medicaid Services (CMS) contracts with Medicare Advantage Organizations (MAOs) and pays Medicare Advantage (MA) plans for managed health care based on a monthly fee per member. The payment is based on the future health care needs and the sickness burden of its members. MA is an alternative to the traditional fee-for-service Medicare.
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On December 18, 2018, CMS issued a final rule that creates a new direction for the MSSP Program, generally referred to as the “Pathways to Success” — which is the government’s dramatic redesign of Accountable Care Organization (ACO) Programs. The rule is complex, but the basic change is simple: