Medicare payment advisors said Friday they have focused on strategies to simplify Medicare’s alternative payment models, including removing the ratcheting effect that makes earning shared savings getting harder For responsible care organizations.

The Medicare Payments Advisory Committee recommends reducing the amount of risk tracking in population-based models.Providers currently have seven tracks to choose from, five in the Medicare Shared Savings Plan and two in ACO REACH model.

Instead, the Centers for Medicare and Medicaid Services can only run tracks with simpler functions. For example, a model could provide 50% sharing savings for small organizations, one 75% sharing savings and losses for mid-sized clinics and hospitals, and one 100% sharing savings and losses for large health systems.

The strategy builds on MedPAC’s previous recommend Let CMS reduce the number of alternative payment models in Medicare and make the remaining payment models more cohesive.The group has discussed The best way to do this over the past few months.The Center for Medicare and Medicaid Innovation is also October The coordination model is a priority for the agency.

MedPAC also recommends eliminating periodic “rebalancing” of ACO spending benchmarks. ACOs can share in Medicare savings if a beneficiary’s costs fall below a specified benchmark level. Since benchmarks are reset each performance period based on the ACO’s past performance, ACOs that generate more performance each year will have to deal with benchmarks that are increasingly difficult to beat, putting long-term participation at risk.

Commissioners envisioned replacing the system with a baseline set at the beginning of the ACO engagement model using historical spending, and then moving forward using external growth factors unrelated to actual ACO spending. Growth factors can be discounted to save on health insurance.

MedPAC’s strategy also recommends that Medicare implement a national bundled payment model for certain types of care events. CMMI already operates bundled payment models for a variety of programs, including Hip and Knee Replacement.

All fee-for-service beneficiaries receiving a treatment would fall under the Medicare model, and those already in ACO would fall under both models during the episode. ACOs can design their own bundled payment arrangements for services not covered by the Medicare model.

MedPAC recommends that CMS consider whether including an episode in the model would increase the number of episodes, discourage ACO participation, reduce health disparities, generate savings beyond ACO’s, and more when deciding what care deserves bundled payments.

“We’re not actually taking a position on whether there should be many or a few episodes… The advice to CMS is to think about how all of this works with the episodes and the ACO,” MedPAC chair Michael Chernew, Harvard professor of health policy, said in a statement. Friday’s meeting.

The Medicare Payments Advisory Committee won’t make any formal recommendations on the strategy this year, but will include the framework in its June report.

Final strategies included in the June chapter could include stronger language on how health equity impacts, as well as more specific recommendations for provider incentives, among other wording changes, according to commissioners’ recommendations Friday.