New ACOs Push CMS Closer to Accountable Care Goals

CMS has announced that more than 700,000 healthcare providers and organizations are participating in one of three accountable care organization (ACO) models, including the Medicare Shared Savings  Program.

Three ACO models—the Shared Savings Program, the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, and the Kidney Care Choices (KCC) Model—will provide accountable care for more than 13.2 million people with Medicare this year, according to the announcement.

The growth in the ACO models brings CMS closer to having 100 percent of Traditional Medicare beneficiaries in accountable care relationships by the end of the decade.

“Through the CMS accountable care initiatives and working with our partners, we have made significant progress in addressing our greatest health care challenges,” CMS Administrator Chiquita Brooks-LaSure said in the announcement. “Health care providers coming together as Accountable Care Organizations provide high quality and equitable care to people with Medicare while improving the sustainability of the Medicare program.”

In a 2022 report, CMS said driving accountable care is one of the agency’s strategic objectives over the next couple of years as it aims to link beneficiaries with providers in ACO models. ACO models are key to progress because the models require healthcare providers across the care continuum to coordinate high-quality care.

“Using the Shared Savings Program as a chassis for testing Innovation Center models will help increase participation in ACO initiatives, bring accountable care to more beneficiaries, especially the underserved, and allow for the scaling of successful innovations and model features such as those that improve quality, reduce inequities, and increase savings into the national Shared Savings Program,” CMS said in the report.

The Shared Savings Program has 456 ACOs and 10.9 million assigned beneficiaries in 2023, a decrease compared to the previous year, CMS stated in the announcement. However, the agency believes policies recently finalized in the Medicare Physician Fee Schedule final rule for the 2023 calendar year will grow participation starting next year when the policies go into effect. Among the policies slated to increase participation are incorporating advance shared savings payments to certain new ACOs and adjusting ACO quality scores based on health equity performance. ACOs in the Shared Savings Program will also be allowed to stay in one-side financial tracks longer.

CMS said in the announcement that it expects up to 4 million more beneficiaries to be assigned to ACOs in the Shared Savings Program over the next several years.

Making up for decreased Shared Savings Program participation is the ACO Reach Model.

The ACO Reach Model is a new CMS Innovation Center demonstration that replaced the controversial Global and Professional Direct Contracting Model (the GPDC Model). ACO Reach emphasizes health equity and tests benchmark adjustments to shift payments to support benefits for underserved communities.

CMS said 132 ACOs are participating in the 2023 performance year, an increase from 99 ACOs the previous year. The ACOs started participation on January 1st and include 48 new ACOs. The ACOs will treat an estimated 2.1 million beneficiaries.

Additionally, CMS announced 130 KCC entities, which are accountable for the quality of care they deliver to aligned beneficiaries. In 2023, the KCC Model will have about 8,400 participating healthcare providers and organizations and nearly 250,000 assigned beneficiaries. Participation is up 87 percent compared to last year, while beneficiary assignment is up 62 percent.