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September 4, 2018

60% of MSSP ACOs saved Medicare money in 2017, new data show

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    Accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) generated net savings of $313.7 million last year, according to data CMS released Thursday.

    Sept. 11 webconference: Unpack CMS's new (proposed) ACO overhaul

    About MSSP

    MSSP encourages ACOs to cut health care costs and improve care coordination by enabling participating ACOs to receive bonus payments if they maintain high-quality care while decreasing Medicare spending compared with their individual benchmarks. The program currently offers three participation tracks that allow ACOs to take on varying amounts of risk.

    Currently, there are 561 ACOs participating in MSSP, and 82% are in Track 1 of the program, which is the only MSSP track that does not require providers to take on two-sided, or both "upside" and "downside," risk. Under MSSP, ACOs can stay in the upside-only risk track for up to six years.

    MSSP performance

    According to the data, 60% of the 472 ACOs that participated in MSSP for the 2017 performance year generated a total of about $1.1 billion in savings that year. CMS paid out about $780 million in bonuses under the program for the 2017 performance year, resulting in a net savings of about $313.7 million.

    The savings occurred as MSSP ACOs gained more experience. David Muhlestein, chief research officer at Leavitt Partners, said, "Over time, … (ACOs) are learning how to better care for the population and manage them."

    The CMS data show ACOs that participated in the MSSP since it launched in 2012 generated $291 million in savings in 2017, with $87 million in net savings after accounting for bonus payments. In comparison, ACOs that started participating in MSSP in 2016 generated $46 million in savings, with CMS paying $80 million in bonuses—resulting in a net loss of $34 million. Overall, 34% of MSSP ACOs received bonus payments in 2017, up from 31% in 2016.

    In addition, more ACOs moved into tracks with risk, Modern Healthcare reports. According to Modern Healthcare, 92% of MSSP ACOs in 2017 were in Track 1 of the program, down from 95% in 2016. CMS last month released a proposed rule that would overhaul MSSP and accelerate the pathway for ACOs to transition to two-sided risk models.

    Some say results show CMS should not push ACOs to take on risk

    Some experts said the results show CMS should not push ACOs to more quickly take on risk. Clif Gaus, president and CEO of the National Association of ACOs, said the "results show that what we have been saying for years—that ACOs are saving Medicare hundreds of millions of dollars, and given sufficient time, one-sided ACOs will return significant savings to the trust funds."

    Some observers have argued that forcing ACOs to take on downside risk sooner could cause some to drop out of MSSP.

    But Adam Boehler, director of CMS' Center for Medicare & Medicaid Innovation, indicated he is not worried about ACOs leaving MSSP. "Our job isn't to have a lot of ACOs. Our job is to improve performance by reducing costs and improving quality of care," he said (Castellucci/Dickson, Modern Healthcare, 8/30; LaPointe, RevCycleIntelligence, 8/30; Herman, "Vitals," Axios, 8/31).

    Sept. 11 webconference: Unpack CMS's new (proposed) ACO overhaul

    To learn more about CMS's proposed ACO overhaul, including how the proposed model would differ from past models, how the changes intersect with MACRA, and what this would mean for the future of value-based care, make sure to register for our webconference on Tuesday, September 11th at 3:00 pm.

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