Will changes to the Shared Savings Program make a difference?

Will changes to the Shared Savings Program make a difference?

Recently, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule change to the Medicare Shared Savings Program (MSSP) that certain Accountable Care Organizations (ACOs) participate in. The goal of the proposal is to improve on the current momentum of the program and create a path for long-term sustainability. To ensure the sustainability, CMS is looking to improve the long-term incentives for ACOs as they continue to provide high quality health care to Medicare beneficiaries.

The proposal looks at the current success of the program, taking into account the achievements and improvements that ACOs have experienced since joining the program. The overall end goal is that improved care becomes standard across the nation. With the new rule, CMS would modify the process of setting benchmarks each year for ACOs. These benchmarks are used to determine an ACO’s performance when they renew their participation in the program.  Currently, the program looks at national fee-for-service expenditures when establishing and updating the ACO’s benchmarks. The new rule acknowledges that health cost trends vary regionally and now takes into account regional fee-for-service expenditures when creating these benchmarks. These regions will be determined based off of any county where more than one assigned beneficiary resides.  Along with a new regional benchmarks, CMS will be providing ACOs time adjust to the new benchmarks by using a phased approach to implementation. All in all these changes will be focusing on creating a more streamlined approach to the methodology when adjusting benchmarks and more clarity when it comes to determining an ACOs shared savings and shared losses.

The Shared Savings Program was established as part of the Affordable Care Act, and 494 ACOs currently participate in that model, according to Definitive Healthcare. The largest by far is Advocate Physician Partners Accountable Care, with nearly 140,000 beneficiaries. The below table shows the top 5 MSSP ACOs based on the number of beneficiaries:

 

Top 5 MSSP ACO's

 

With the new rule proposal it will be interesting to see the changes these ACOs experience with both their benchmark expenditures and total expenditures as the benchmark focus shifts towards regional over national data.

Definitive Healthcare has the most up-to-date, comprehensive and integrated data on ACOs, payors and other connected care organizations. Our connected care database tracks just over 1,200 US ACOs and includes ACO key contact information as well as the member provider organizations.

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