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The Centers for Medicare & Medicaid Services (CMS) continues to press forward in the transformation of payment models away from one-sided (no risk) options toward some shared downside risk with providers. The Medicare Shared Savings Program (MSSP) ACOs are included in this transformation, leaving most networks facing a choice:

1) To gracefully exit the MSSP legacy Track 1 at the conclusion of their ACO term, or;

2) To establish a profitable pathway to participate in the BASIC or ENHANCED tracks starting in the January 1, 2020 cycle.

Some ACOs have already chosen to proceed with applying for the July 1, 2019 start. For those networks, significant work is already underway. For the others, making the decision to exit or continue should be a priority this quarter. Survey results released by Leavitt Partners and the National Association of ACOs (NAACOS) shows that approximately half of the 203 surveyed networks are considering an exit from MSSP, which would make those participating providers subject to Merit-based Incentive Payment System (MIPS) reporting (among other operational changes.) The decision to exit or continue is based on a number of factors, some of which are difficult to measure. Nonetheless, the deadline for decision-making is coming up, with the Notice of Intent to Apply (NOIA) window opening on June 11, 2019 for the January starters.

Are you weighing the decision to exit or continue with MSSP?

Our team of experts is experienced in working with organizations to develop the evaluation criteria to include in your decision-making process. We have developed a systematic decision-making pathway tool for ACO leadership and governance bodies to use to arrive at a go/no-go decision. If your decision is to exit the program, we have an operational plan ready to successfully transition participating providers to other networks, or to successfully prepare them for operations outside the network that continue the important focus on quality performance as a truly independent Medicare provider under Medicare Access and CHIP Reauthorization Act (MACRA).



We are excited that Laurie J. Ringlein has partnered with our team and is serving as Sr. Vice President. Ms. Ringlein is an expert in health plan transformation and optimization; she has worked in managed care for over 30 years. Check out our website to explore services we offer health plans and risk bearing organizations.


We are pleased to announce that Matthew Warfield will be joining our team on June 10 as an Analyst! Mr. Warfield joins us from graduate school with an academic background in Applied Economics. His expert analytics capabilities will empower us with data-driven recommendations.


His skills will be important in our work to evaluate and capitalize on market opportunities to: expand service areas, move profitably into value-based payment arrangements and save unnecessary costs during care delivery.
Mr. Warfield will be based in our Los Angeles office.


Our team is still growing! We will be seeking both a Consultant and Manager to join our team in the second half of 2019. We work hard to deliver high quality work, coupled with deep industry expertise. Keep an eye on our jobs site to learn when we add new openings!




Cardinal Consulting Group is proud to support Gay for Good! Last Sunday, our team joined other community leaders to honor Gay for Good’s volunteers, founders and to celebrate 10 years of their service to communities across the nation. The exceptional event raised funds to continue their mission to grow new chapters and make a difference nationwide. To learn more about Gay For Good or to donate to their cause, please visit their website.



What We’re Reading This Quarter

The Health Plan of Tomorrow: How interoperable data and a renewed focus on wellness is transforming business models
Deloitte takes a look at the shift in health plans to focus on consumer-centric models that engage members in health and well-being. There is strong evidence that using wellness data can help drive clinical decision-making in an acute episode, as well as to curb spend related to otherwise-unmanaged chronic diseases. We see tracking wellness and social determinants as a logical path for health plans to begin developing a meaningful population health management program.

Bundled-payment model’s participation dips 16% in five months
Modern Healthcare dives into the numbers from CMMI showing approximately 16% of BPCI Advanced (BPCIA) participants chose with withdraw during the “no-penalty withdraw period” last July. This comes along with the news of a fresh round of BPCIA applications will be up for evaluation this summer for a January 1, 2020 start. This reminded us that a key consideration for providers evaluating a 2020 application is to confidently identify where consistent reduction in variability (likely though process improvement and/or quality improvement) will reliably generate less Medicare fee-for-service spend over time. Further, we got to thinking: finding and reliably capturing reductions in acute/post-acute costs directly attributed to bundled cases could provide systemwide value for inpatient & outpatient services. There are certainly some compelling mechanisms to align specialty provider incentives with the quality and efficiency goals of BPCIA.

It’s not about working from home; it’s about a shift in mindset
As a growing firm, we are focused on building the right culture for our professional staff so they can thrive alongside our clients. Crain’s takes a look at some nontraditional (but effective) tactics to engage with staff of all levels in creating the best complement of work/life activities. A “one size fits all” workplace policy is unlikely to produce desired results and/or increase team satisfaction. While it’s difficult to introduce flexibility into many positions, leadership may find it useful to re-think how to engage with administrative staff to bring out the best side of their talented workforce.

What are you reading?
Our team would enjoy hearing what you are reading lately, any trends you think are relevant, or even chat about feedback you have for The Compass!
Don’t hesitate to drop us a line!


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