ACOs in models with downside risk were significantly more likely to earn performance payments than those without it. Just 55% of ACOs in one-sided risk models received shared savings compared to 88% in two-sided risk models.
Medicare Shared Savings Program ACOs earned almost $2.3 billion in bonuses and saved taxpayers almost $1.9 billion.
"The 2020 Shared Savings Program results continue to demonstrate the impact ACOs have in improving quality and lowering health care costs," CMS Administrator Chiquita Brooks-LaSure said in a news release. "CMS is similarly committed to moving healthcare providers to value-based payment and looks forward to partnering with the ACO community in a continued effort to advance these goals and promote affordability and sustainability."
President Joe Biden's administration recently laid out its vision for the future of value-based care in a Health Affairs blog post, saying it would emphasize coordinated, team-based care and hold providers more accountable for patient outcomes. That likely means an even greater reliance on total cost-of-care models like ACOs and pushing providers to take on more financial risk.
"While voluntary models can demonstrate a proof of concept, they limit the potential savings and full ability to test an intervention because participants opt-in when they believe they will benefit financially and opt-out (or never join) when they believe they are at risk for losses," the blog post says.