CMS: More patients treated by ACOs

The Centers for Medicare & Medicaid Services (CMS) has announced that 11 million patients with Medicare will be treated by Shared Savings Program Accountable Care Organizations (ACOs) in 2022.

According to a news release, the announcement came as part of the agency’s annual summary of the Medicare Shared Saving Program; Medicare’s national ACO program.

“With one in every five health care dollars paid by Medicare, we can strengthen and transform our health care system,” CMS Administrator Chiquita Brooks-LaSure says in the release. “(ACOs) present an invaluable opportunity to move Medicare toward person-centered care.”

The release says 66 new ACOs have joined the program and 140 existing ACOs renewed their participation, bringing the total ACOs in the program to 483 this year. The number of patients with Medicare who receive healthcare from a provider in a Shared Saving Program ACO is up 3 percent, or 324,000, from 2021.

“Over the last decade, Medicare has promoted participation in value-based care to reward better care, smarter spending, and improved outcomes,” Meena Seshamani, MD, CMS deputy administrator and director of the Center for Medicare, says in the release. “CMS’ commitment to value-based care has never been stronger. As we continue working toward 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 we have more work to do.”

ACOs have been a key innovation in moving CMS’ payment systems away from volume-based payment toward a system which pays for value and outcomes. They are held accountable for spending and quality performance. ACOs also support integrated care for Medicare beneficiaries by ensuring their physicians work as a team, the release says.

Last year, the National Association of ACOs (NAACOS) lamented that at the end of the Trump administration 477 ACOs were participating in the program, a drop from the 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.

Later in 2021, the Center for Medicare and Medicaid Innovation (CMMI) laid out a goal for every fee-for-service Medicare beneficiary to be getting care from a provider who’s part of an ACO by 2023.

To achieve that goal, CMMI outlined the following strategic objectives:

• Increasing the number of patients in a provider relationship that includes accountability for quality and total cost of care—including the objective of having every Medicare fee-for-service beneficiary in an accountable care relationship by 2030.
• Embedding health equity in every aspect of CMMI models with an increased focus on historically underserved populations. New models will include patients from these groups as well as safety net providers, and will require participants to report demographic data on their beneficiaries and on social determinants of health
• Supporting care innovations by enabling integrated, person-centered care, which the paper defines as “integrating individuals’ clinical needs across providers and settings, as well as addressing their social needs.” It cites behavioral health, palliative care and care for patients with complex needs as examples of areas that can be better integrated with primary care
• Improving access to health care by addressing affordability issues. The paper notes that while health spending growth was slower in 2010-2019 than the previous decade, its continuing rise remains unsustainable for governments and individual households. Consequently, “affordability is an important consideration in achieving the Innovation Center’s vision of driving broad system transformation.”
• Aligning health care priorities and policies within CMS itself and with outside stakeholders such as providers, commercial payers, states, and beneficiaries with the goals of improving quality, achieving equitable outcomes and reducing costs