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With the publication of the Medicare Shared Savings Program (MSSP) Final Rule on December 21, the Centers for Medicare & Medicaid Services (CMS) clearly signaled that the Trump administration is serious about holding accountable care organizations (ACOs) in Medicare more financially accountable for costs and quality. However, Medicare ACOs may not be the only ACOs affected by this change.
Medicaid tends to follow Medicare’s lead in many areas related to payment and delivery system reform, and ACOs are no exception. Many state-led Medicaid ACO payment models are based on an MSSP foundation, as states prefer to align closely with the Medicare model to encourage participation in the Medicaid models, reduce provider burden, and allow ACOs to create operational efficiencies across payers. Since there are now significant changes to the MSSP, it is worth exploring how these changes may affect Medicaid ACO models that are already in place, as well as those that are currently under development.