The move to value-based care—where payment for volume of services is being supplanted by payment for outcomes of care—has proceeded with remarkable speed since the Affordable Care Act (ACA) went into law a mere ten years ago. Payment for outcomes increasingly focuses on holding providers of healthcare responsible for total costs of care.
Accountable Care Organizations (ACOs) began in 2014 under the direction of the Centers for Medicare and Medicaid Services’ (CMS) Shared Savings Program (MSSP). Four years later in 2018, population-based, at-risk payment was applied to only 5.1% of Alternative Payment Model (APM) program participants1. In 2019, the ACO payment structure underwent a first major revision as outlined in Pathways to Success, moving from Alternative Payment Models (APMs) to Advanced Alternative Payment Models (AAPMs), which promoted greater financial risk. Pathways to Success (labeled in the diagram below as “ACO 2.0”) represents a faster move to value by forcing participating ACOs into risk models on a mandatory annual glide path.