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ACO participation dropped during Trump administration


NAACOS blames the drop on a number of policies implemented by the last administration.

The number of accountable care organizations (ACOs) participating in the Medicare Shared Savings Program fell during the Trump administration in part due to policies implemented by the Centers for Medicare & Medicaid Services (CMS) during that time.

According to a news release from the National Association of ACOs (NAACOS), there are 477 ACOs participating in the value-based payment program, down from a high of 561 in 2018 and the lowest since the 480 participants in the Trump administration’s first year in office.

The association places the blame on several of the Trump administration’s policies, including 2018 “Pathway to Success” changes which gave limited time before ACOs started taking on financial risk and cut the share of saving they were eligible to keep. Even with these changes, though, the ACOs in the Shared Savings Program still collectively care for 10.7 million Medicare patients.

“Our healthcare payment and delivery system needs to desperately change, and ACOs offer the leading way to make that happen,” Clif Gaus, president and CEO of NAACOS, says in the release. A steady erosion of ACO participation damages our ability to get to where we need to be. Health Secretary Nominee Xavier Becerra and the incoming Biden administration need to re-examine the balance of incentives and risk to ensure ACO growth and continued savings to Medicare, which ACOs have a history of producing.”

Despite the drop in ACOs, the Shared Savings Program served 11.2 million seniors in 2019 and saved Medicare $2.6 billion and $1.2 billion after accounting for shared savings bonuses and collecting shared loss payments, the release says.

The release gathers some of the recommendations NAACOS has to attract new ACOs to the program, including:

  • Offering a new opportunity to apply for a July 2021 start date
  • Increase ACO shared savings rates
  • Fix key benchmarking and risk adjustment issues
  • Allow more time before requiring risk
  • Revisit recently finalized quality policies
  • Minimize administrative burden
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