Going into the 12th year since it brought accountable care into the healthcare lexicon, the Medicare Shared Savings Program (MSSP) continues to evolve, with CMS making changes and participants fine-tuning best practices.
Starting with 220 accountable care organizations (ACOs) in 2012-13, the MSSP grew to 561 in 2018. However, the number has been below 500 in all but one year since. One drag on participation has been rules requiring ACOs to take on financial risk more quickly.
As part of CMS’s effort to reverse that trend, key changes came to the program in 2023. The agency sought to strengthen financial incentives for long-term participation by modifying the benchmarking methodology and bolstering financial support for certain low-revenue ACOs and those serving high-risk and dual-eligible populations, according to an HFMA fact sheet.
Although the number of MSSP ACOs subsequently dipped to 456, the lowest total since 2016, that was in large part because of the new ACO REACH program, which launched last year with 132 ACOs and generally features greater levels of risk and reward than the MSSP. Combined, the federal ACO programs in 2023 included more than 1,450 hospitals and encompassed 13 million beneficiaries.
In a January 2023 statement, the National Association of ACOs said it expected “2023 to be a turning point for ACOs and growth in participation to really accelerate in 2024,” in the wake of the changes implemented.
Going into 2024, CMS made adjustments that are less sweeping but still significant, including revisions to quality-related requirements and to processes for determining beneficiary assignment. There also were further refinements to the benchmarking methodology and advance payments, as described in another HFMA fact sheet.