More Beneficiaries, But Fewer ACOs for Medicare Shared Savings Program

Accountable care organizations (ACOs) in the Medicare Shared Savings Program will care for more beneficiaries in 2022, making it the largest alternative payment model in Medicare despite lackluster ACO participation numbers this year, according to new program data from CMS.

Over 11 million Medicare beneficiaries will be attributed to a provider practicing as part of a Medicare Shared Savings Program ACO in 2022, the data shows. That is up from 10.7 million beneficiaries last year and just 3.2 million beneficiaries in 2012 and 2013, when the Shared Savings Program started.

But the number is not a record high. That goes to the ACO class of 2020, which cared for 11.2 million Medicare beneficiaries. Despite this, the increasing number after last year’s slight dip is encouraging to CMS as overall ACO participation plateaus.

“Over the last decade, Medicare has promoted participation in value-based care to reward better care, smarter spending, and improved outcomes,” Meena Seshamani, MD, PhD, CMS Deputy Administrator and Director of the Center for Medicare, said in an announcement on Wednesday. “CMS’ commitment to value-based care has never been stronger. As we continue working toward our goal of increasing the number of people in a care relationship with accountability for quality and total cost of care, we celebrate this increase in ACO participation, and know we have more work to do.”

CMS’ Innovation Center recently announced that it expects to have all traditional Medicare beneficiaries cared for by accountable providers by 2030.

ACO participation in the Medicare Shared Savings Program will increase, CMS predicted based on the new program dataset. They expect 483 ACOs to participate this year, including 66 new ACOs and 140 existing ACOs that renewed their participation for a new agreement period starting Jan. 1, 2022.

However, the increase is modest compared to last year when 477 ACOs participated and in 2020 when 517 ACOs participated. In fact, the data shows that ACO participation has remained relatively flat since 2018 when the program saw record ACO participation growth, with a total of 561 ACOs in the program. Prior to the 2018 performance year, ACO participation had been steadily increasing.

The National Association of ACOs (NAACOS) called yesterday’s announcement about ACO participation numbers disappointing.

“When considering former Next Generation ACOs who moved into MSSP and the fact that there was no opportunity to join the model in 2021, you could consider this a shrinking of this important ACO model,” Clif Gaus, ScD, president and CEO of NAACOS, said in a public statement. “Today shouldn’t be celebrated but instead should be a call to action for policymakers to correct this trend and address incentives to spur participation in a voluntary program that has repeatedly yielded savings and provides high quality care.”

NAACOS pointed out that ACO participation has been shaky since CMS implemented the Pathways to Success policies after the 2018 performance year. The policies primarily encourage Medicare Shared Savings Program ACOs to assume downside financial risk sooner through revised pathways, which were formerly known as tracks.

The latest program data shows that the number of participating ACOs qualifying for additional bonuses in Medicare for taking on downside financial risk and meeting quality and cost goals has increased from just 34 percent to 50 percent. CMS noted in its announcement that it has encouraged providers to participate in these payment arrangements since the launch of the Quality Payment Program.

However, NAACOS found in a search of the data that many of the new ACOs already have experience with the now-expired, but risk-heavy Next Generation ACO Model. The Next Generation ACO Model offered participating ACOs up to 100 percent downside financial risk.

Overall, 59 percent of ACOs participating in the Medicare Shared Savings Program in 2022 are taking on downside financial risk.

NAACOS also found that nearly 529,000 physicians and other non-physicians are participating in Medicare Shared Savings Program ACOs in 2022, as well as over 1,300 hospitals.

The industry group advised CMS to make program changes to encourage greater participation, especially if the agency plans to meet new accountable care goals by 2030. Those changes include increasing the shared savings rates, addressing key benchmarking and risk adjustment issues, allowing more time before requiring downside risk, minimizing administrative burdens, rethinking quality reporting requirements, and providing more timely and complete data.

“With Medicare spending continuing to rise to out-of-control levels and ACOs proving they can effectively increase quality and lower spending, more focus needs to be on increasing the size of ACO programs in traditional Medicare, which needs to happen at levels much greater than what we’ve seen today,” Gaus stated.