561 ACOs Participating in Medicare Shared Savings Program in 2018

Earlier this month, CMS announced that 561 accountable care organizations (ACOs) will be participating in the Medicare Shared Savings Program (MSSP) in 2018, with 10.5 million assigned beneficiaries.

According to CMS, there are 124 new ACOs, 65 ACOs that renewed their contracts, and 372 that are continuing the program but are not up for renewal. MSSP has seen a steady growth in the amount of participating ACOs since it began in 2012, signifying a mounting interest in working toward increased quality of care for patients.

Since then, the program has jumped from 220 ACOs covering 3.2 million people in 2012 to 338 ACOs covering 4.9 million people in 2014, and to 433 ACOs covering 7.7 million people in 2016. This year saw another significant increase, up from 480 ACOs covering 9 million people in 2017.

“ACOs play a critical role in transforming our nation’s healthcare system through value-based care. The growth of ACOs in 2018 shows the continued commitment from the Administration to increase value in the Medicare program through ACOs,” said Clif Gaus, ScD, president and CEO, National Association of ACOs, in a statement. “ACOs demonstrate a commitment to achieving a healthier population and focus on quality, cost, wellness, and outcomes as their primary goals. We are pleased to welcome the new and continuing ACOs.”

The 1-sided risk track continues to be the most popular for the program, with 460 (82%) of ACOs on Track 1, meaning they do not assume a downside risk if they do not lower growth in Medicare expenditures. The remaining participating ACOs will take on a 2-sided risk. Fifty-five (10%) ACOs are participating in the Track 1+ model, under which they assume limited downside risk. Forty-six (8%) of ACOs are participating in Tracks 2 and 3 of the program, in which they may share in savings or repay financial losses depending on performance.

According to Gaus, the increase in the number of ACOs participating in 2-sided models is an encouraging sign that more ACOs are preparing to take on risk; however, it is vital to recognize all the time and effort needed for these ACOs to be ready to assume risk. Gaus also cited a need to improve the program as a whole in order to provide stability and demonstrated success so ACOs will feel confident when entering into these risk-models.

Physicians, hospitals, and other facilities make up 324 (58%) of the ACOs in 2018, physicians alone make up 171 (30%), and federally qualified health centers and rural health clinics make up 66 (12%).

Soon after CMS announced its 2018 class of participating ACOs, Caravan Health announced the addition of 15 new ACOs, which include 103 community hospitals, highlighting a significant interest in population health among community hospitals. The organization has helped form ACOs around the country, aiding them in achieving quality improvements and cost savings.

In March 2017, Caravan Health released a report that suggested that joining an ACO could help clinicians raise Medicare performance scores up to 30%, boosting their chances of higher reimbursement relative to competitors. The report compared what payments would look like for clinicians inside and outside of ACOs under MACRA, where performance data from 2017 would be used to calculate payments for 2018.