Increase ACO Opportunities for Global Risk

The Medicare Shared Savings Program (MSSP) is the largest federal initiative that promotes accountable care. Accountable care organizations (ACOs) represent groups of clinicians that take responsibility for patients’ health outcomes and costs. Evidence from MSSP shows that ACOs taking on downside risk have better cost and quality outcomes, but there is not currently a permanent program for ACOs to bear full risk. ACO REACH – offered by CMMI separately from MSSP – is currently the only full risk option but is scheduled to end after 2026. Increase ACO Opportunities for Global Risk

ACOs in Downside Risk Achieve Higher Savings and Quality

An analysis of all MSSP ACOs from 2022 and 2024 found that:

• ACOs achieve greater savings as they take on risk. ACOs in downside risk achieve nearly double the gross
  shared savings as those in upside-only models (Figure 1). Our companion brief shows that savings
  increased as ACOs increased risk exposure across MSSP tracks. Downside risk appears to sharpen
  organizational focus on cost reduction, accelerating the organizational maturity required to succeed in
  value-based care

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