CMS Reports ACO Participation Continues to Grow

During his remarks at the J.P. Morgan Annual Health Care Conference, Jan. 11, 2016, Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt addressed not just meaningful use (see page 6) but also praised recent data on ACOs as “strong evidence that ACOs will be part of ushering in the new wave of alternative payment models.” That same day, CMS reported that 121 new participants were joining the Medicare ACO program. Those new participants bring the total participation numbers to 477 ACOs serving 8.9 million beneficiaries. Sixty-four of those ACOs are risk-bearing. The ACO models currently in effect include the Shared Savings Program, Pioneer, Next Generation, and Comprehensive ESRD Care ACO models.

Next Generation ACOs are leading the way with regard to risk sharing alternatives allowing participants to take on up to 100% risk. This ACO model involves prospectively set benchmarks and, as Slavitt noted in his Jan. 11 remarks, they include “innovative options like telemedicine, home visits, and direct consumer incentive and engagement options.”

The Medicare Shared Savings program added 100 new ACOs. Twenty-two of the MSSP ACOs have opted to transition to Tracks 2 and 3, which allow for more risk sharing. Thirty-nine MSSP ACOs will now be participating in the ACO Investment Model (AIM) which involves pre-paid shared savings to encourage ACO formation in rural and underserved areas and transitions to performance-based risk sharing models. Slavitt summed up the numbers on ACOs, praising the progress made and promising continued improvement: “[ACOs] have demonstrated improvements in quality, patient experience and have been certified to reduce costs,” said Slavitt. “There will still be progress and setbacks and we will continually improve.”

Takeaway: Participation in ACOs continues to grow with participants increasingly moving to accept more risk.