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The Centers for Medicare and Medicaid Services (CMS) recently finalizedchanges to the Medicare Shared Savings Program (MSSP), its primary accountable care organization (ACO) program and most significant approach to constraining ballooning program costs while improving quality. These changes will require ACOs to transition more quickly to two-sided risk. The program has continued to grow and demonstrated some savings, as detailed in recent posts (Part 1 and Part 2), with 10.5 million beneficiariesand 561 MSSP ACOs in 2018. Yet, many have raised concerns that ACOs will leave the voluntary program as a result of new requirements to accept two-sided risk.
While two-sided risk may provide additional motivation for ACOs to reduce expenditures, this strategy does little to address the underlying problem that many ACOs have difficulty in identifying the best opportunities to improve value. Published programwide evaluations have not produced clear evidence of effective interventions such as coordination of care for high-risk patients and preventing ambulatory sensitive conditions. However, given the heterogeneity of ACO composition, opportunities, and chosen strategies, programwide evaluations are not designed to identify successful approaches at the individual ACO level.