The Centers for Medicare & Medicaid Services (CMS) announced Thursday that this is the sixth consecutive year the Medicare Shared Savings Program (MSSP) has generated overall savings and high-quality performance results.
CMS said the $1.8 billion in savings represent the second-highest annual savings accrued for Medicare since the program was established more than 10 years ago.
“The Medicare Shared Savings Program helps millions of people with Medicare experience coordinated health care while also reducing costs for the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure in the announcement. “CMS will continue to improve the program, and it is exciting to see that Accountable Care Organizations (ACOs) are continuing to be successful in delivering coordinated, high-quality, affordable, equitable, person-centered care.”
RELATED: ACOs saved Medicare $1.6B in Shared Savings Program in 2021
ACOs in the program are groups of doctors, hospitals, and other health care providers who collaborate and provide coordinated, high-quality care to people with Medicare, focusing on delivering the right care at the right time while avoiding unnecessary services and medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, the ACO may be eligible to share in the savings it achieves for the Medicare program (also known as performance payments). This also drives lower health care costs for people with Medicare, who see lower out-of-pocket spending on avoidable health care utilization like emergency department visits because the ACO has better coordinated their care, CMS said.
As of January, Shared Savings Program ACOs include over 573,000 participating clinicians who provide care to almost 11 million people with Medicare. Based on the program’s success and opportunities to continually improve value for people with Medicare and the health care system, CMS has set a goal that 100 percent of people with traditional Medicare will be part of an accountable care relationship by 2030.
“We are encouraged and inspired by six consecutive years of savings and high-quality care, with 2022 being one of the strongest years of performance to date,” said Meena Seshamani, M.D., Ph.D., CMS deputy administrator and director of the Center for Medicare. “The Shared Savings Program is Medicare’s permanent, flagship Accountable Care Program, and we look forward to continually improving and growing the program, expanding the reach of participating ACOs, and addressing critical health disparities across the country.”
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ACOs had a higher average performance on quality measures they are required to report to share in savings compared to other similarly sized clinician groups not in the program. This includes statistically significant higher performance for quality measures related to:
- Diabetes and blood pressure control
- Breast cancer and colorectal cancer screening
- Tobacco screening and smoking cessation
- Depression screening and follow-up
Approximately 63 percent of the 483 participating ACOs earned payments for their performance in 2022. Those with the greatest net savings were low-revenue ACOs, which were made up of physicians, included a small hospital, or served rural areas:
- Low-revenue ACOs saw an average of $228 per capita in net savings compared to high-revenue ACOs, which had $140 per capita net savings
- ACOs comprised of 75 percent primary care clinicians or more saw $294 per capita in net savings, more than twice as much
“These results underscore how important primary care is to the success of the Shared Savings Program and demonstrate how the program supports primary care providers,” CMS said. “As articulated in a recently published article, the Innovation Center continues to explore testing models and features to support Shared Savings Program ACOs in increasing investment in primary care services."
According to the National Association of ACOs (NAACOS), ACOs have generated more than $21 billion in gross savings for Medicare over the last decade. More than 700,000 physicians and other non-physicians participate in Medicare ACOs, caring for more than 13 million beneficiaries today, making it far and away the largest alternative payment model in Medicare.
“Every year, the body of data on how ACOs are improving our fragmented health system grows, and this year is no different,” said Clif Gaus, Sc.D., president and CEO of NAACOS, in response to the CMS announcement. “ACOs continue to provide more of what patients want and deserve--affordable, high-quality, coordinated, and personalized care.”
Meanwhile, in the 2024 Physician Fee Schedule proposed rule, CMS proposed changes to MSSP that would promote participation among health care providers and promote equity, especially in rural and underserved areas, for more people with Medicare. CMS proposes increasing the number of people receiving high-quality, accountable care by assigning more people who receive care from nurse practitioners, physician assistants, and clinical nurse specialists to ACOs. In addition, CMS proposes changes to the benchmark methodology to encourage participation by ACOs caring for medically complex, high-cost beneficiaries to join the program. These changes would further advance CMS’ overall value-based care strategy of growth, alignment, and equity, building on changes finalized in 2022, which included the establishment of advance investment payments for ACOs in rural and underserved communities, changes to the benchmark methodology, more time to transition to downside risk, and a health equity adjustment that rewards excellent care delivered to underserved communities. Public comments on the CY 2024 Physician Fee Schedule proposed rule are due by September 11.