More Medicare beneficiaries will receive care from providers in Medicare Shared Savings Program accountable care organizations this year, but the number is still lower than it was in 2020, new data show.
Nearly 1 in 5 Medicare enrollees will be treated by Shared Savings Program ACO providers this year, a slight increase from 2021 but lower than during 2020, the Centers for Medicare and Medicaid Services disclosed in projections published Jan. 26. In 2022, these ACOs will cover 11 million people compared with 10.7 million in 2021 and 11.2 million in 2020, according to CMS data.
CMS also announced that 66 new ACOs joined the program as of Jan. 1, although this includes 20 in their second or third agreement periods. According to the National Association of ACOs, another 40 of those listed as new have been in ACOs previously or are part of existing multi-ACOs.
An additional 140 ACOs signed on for another agreement period this year, bringing the total to 483. Last year, 477 ACOs participated, down from 517 in 2020.
More ACOs are also taking on risk this year, with 59% in two-sided risk tracks compared with 41% in 2021.
ACOs are made up of doctors, hospitals and other providers that 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 Medicare and on quality metrics.
As the largest alternative payment model in Medicare, the Shared Savings Program is part of a broader CMS strategy to move toward value-based payment arrangements. The Center for Medicare and Medicaid Innovation announced a goal last year to move all Medicare beneficiaries into one of these arrangements by 2030.
"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," Center for Medicare Director Dr. Meena Seshamani said in a news release.
However, the National Association of ACOs is unsatisfied with the modest increase in participating ACOs and covered beneficiaries. CMS didn't accept new participants in 2021 because of the COVID-19 pandemic, and some of the ACOs that CMS says are new actually just switched over to the Shared Savings Program from the now-defunct Next Generation ACO Model, according to the industry organization.
Shared Savings Program participation hasn't rebounded from the Pathways to Success policy introduced in 2018, which pushed more ACOs into risk-bearing arrangements.
"Today shouldn't be celebrated but instead should be a call to action for policymakers to correct this trend and address incentives to spur participation in a voluntary program that has repeatedly yielded savings and provides high-quality care," National Association of ACOs President and CEO Clif Gaus said in a news release.
CMS' goal of getting all Medicare beneficiaries into value-based care arrangements is laudable, but the agency needs to encourage more ACO participation, the trade group argues. Increasing ACOs' shared savings rates, fixing issues with ACO benchmarks that make it difficult to achieve savings, allowing more time for organizations to move into risk, reducing administrative burden, providing better data and reshaping quality reporting requirements would help, according to the National Association of ACOs.
Separately, CMMI runs the Direct Contracting Model, which builds on the Shared Savings Program and Next Generation ACO Model. CMS paused new applications for 2022, but applicants that deferred their start dates and former Next Gen applicants will still begin this year, according to the National Association of ACOs. CMMI has yet to announce the Direct Contracting participants.
"NAACOS is waiting to see what participation is like in the new Direct Contracting Model, another accountable care model. Hopefully, that will account for some of the lack of growth in the Shared Savings Program," Gaus said.