Participation in Medicare Shared Savings ACO increases slightly for 2022

More Medicare beneficiaries will receive care from providers in the care organizations responsible for Medicare’s shared savings program this year, but the number is still lower than it was in 2020, according to new data.

Nearly one in five Medicare enrollees will be treated by Shared Savings Program ACO providers this year, a slight increase from 2021 but lower than 2020, the Centers for Medicare and Medicaid Services revealed in projections. published on Wednesday. In 2022, these ACOs will cover 11 million people compared to 10.7 million in 2021 and 11.2 million in 2020, according to CMS data.

CMS also announced that 66 new ACOs had joined the program as of January 1, although this includes 20 in their second or third agreement period. According to the National Association of ACOs, another 40 people listed as new have previously belonged to ACOs or are part of existing multi-ACOs.

A further 140 ACOs signed up for another agreement period this year, bringing the total to 483. Last year, 477 ACOs participated, compared to 517 in 2020.

More ACOs are also taking risks this year, with 59% in bilateral risk runs compared to 41% in 2021.

ACOs are made up of doctors, hospitals, and other providers who coordinate care for Medicare beneficiaries. Provider participation in ACOs is voluntary, and those who join can earn bonuses based on how much money they save in Medicare and on quality measures.

As Medicare’s most prominent alternative payment model, the Shared Savings Program is part of a larger CMS strategy to shift to value-based payment arrangements. The Center for Medicare and Medicaid Innovation last year announced a goal of transitioning all Medicare beneficiaries to one of these arrangements by 2030.

“CMS’s commitment to value-based care has never been stronger. As we continue to work towards our goal of increasing the number of people in a care relationship with accountability for quality and total cost of care, we celebrate this increase in ACO participation, and know that we still have work to do,” Center for Medicare Director Meena Seshamani said in a press release.

However, the National Association of COAs is not happy with the modest increase in participating COAs and beneficiaries covered. CMS has not accepted new participants in 2021 due to the COVID-19 pandemic, and some of the ACOs that CMS says are new have actually just transitioned to the next-generation ACO Model Shared Savings Program, now defunct, according to the industry. organization.

Participation in the shared savings program has not rebounded since the Pathways to Success policy introduced in 2018, which pushed more ACOs into risky deals.

“Today should not be celebrated, but rather should be a call to action for policymakers to correct this trend and provide incentives to boost participation in a voluntary program that has repeatedly generated savings and provides high quality care,” said the President and President of the National Association of COAs. said CEO Clif Gaus in a press release.

CMS’s goal of bringing all Medicare beneficiaries into value-based care arrangements is laudable, but the agency needs to do more to encourage participation in the ACO, according to the trade group. Increase ACO shared savings rates, resolve issues with ACO referrals that make it difficult to achieve savings, allow organizations more time to spend on risk, reduce administrative burden, provide better data, and reshape requirements quality reporting would help, according to the National Association of COAs.

In addition, CMMI manages the direct contract model, which is based on the shared savings program and the new generation ACO model. CMS has suspended new applications for 2022, but applicants who have postponed their start dates and former Next Gen applicants will still start this year, according to the National Association of COAs. CMMI has not yet announced the participants in the direct contracting.

“NAACOS is waiting to see what participation looks like in the new direct contract model, another responsible care model. Hopefully that will explain some of the lack of growth in the shared savings program,” Gaus said.

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