A trio of publications from the Centers for Medicare and Medicaid Services (CMS) leadership this year has clarified and advanced the federal strategic vision for value-based care. In January, leaders reinforced their commitment to value-based care with the goal that “100 percent of people with Original Medicare will be in a care relationship with accountability for quality and total cost of care by 2030.” Meena Seshamani, director of the Center for Medicare, identified accountable care organizations (ACOs) as a key component of the strategy to improve health equity. And most recently, CMS leaders put forward a shared vision for using the Medicare Shared Savings Program (MSSP) as a chassis for testing new care transformation models and features. We applaud the clarity and vigor of these strategies, but achieving these goals will require urgency and action on several fronts.
Today, about 11 million out of 30 million original Medicare beneficiaries are in ACOs that would count toward this goal. To achieve 100 percent, approximately 3.6 million beneficiaries must move into accountable models each year until 2030. In 2022, by our calculations based on public statements from CMS officials, we estimate that MSSP and Direct Contracting (now ACO Realizing Equity, Access, and Community Health, or REACH) collectively grew by only 1.3 million beneficiaries. Clearly CMS must do something different to accelerate change.