On Tuesday, Aug. 30, officials at the Centers for Medicare & Medicaid Services (CMS) announced the latest financial and quality results from the Medicare Shared Savings Program (MSSP), touting the overall savings to the Medicare program that the participating accountable care organizations (ACOs) participating in the program have achieved over the past program year. Meanwhile, the major national association representing ACOs weighed in, and the leaders of numerous ACOs around the country boasted of their savings in the program.
The press release announcing the results, posted to the agency’s website, began thus: “The Centers for Medicare & Medicaid Services (CMS) announced today that the Medicare Shared Savings Program, through its work with Accountable Care Organizations (ACOs) – groups of doctors, hospitals and other health care providers -- saved Medicare money while continuing to deliver high-quality care. Specifically, the program saved Medicare $1.66 billion in 2021 compared to spending targets. This marks the fifth consecutive year the program has generated overall savings and high-quality performance results.
“This program has delivered more than $1.6 billion in savings and delivered high-quality health care to millions of people,” Health and Human Services Secretary Xavier Becerra said in a statement contained in the press release. “Just last month, we proposed ways to further grow and expand this successful program, especially in rural and underserved communities. The Biden-Harris Administration will continue to do everything we can to strengthen Medicare and ensure everyone can access high-quality, affordable health care.”
CMS Administrator Chiquita Brooks-LaSure added that “The Medicare Shared Savings Program demonstrates how a coordinated care approach can improve quality and outcomes for people with Medicare while also reducing costs for the entire health system. Accountable Care Organizations are a true Affordable Care Act success story, and it is inspiring to see the results year after year. The Biden-Harris Administration and CMS are committed to a health care system that delivers high-quality affordable, equitable, person-centered care – and a Medicare program that can deliver just that,” she said.
The press release continued thus: “Shared Savings Program ACOs are groups of doctors, hospitals, and other health care providers who collaborate to give coordinated high-quality care to people with Medicare, focusing on delivering the right care at the right time, while avoiding unnecessary services and medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, the ACO may be eligible to share in the savings it achieves for the Medicare program (also known as performance payments).”
And, the press release noted, “Over the past decade, the Shared Savings Program has grown to one of the largest value-based purchasing programs in the country. Value-based purchasing programs focus on the quality of care provided to people on Medicare, not just the quantity of services. As of January 2022, Shared Savings Programs include over 525,000 participating clinicians who provide care to more than 11 million people with Medicare. Based on the program’s success and opportunities to continually improve value for people with Medicare and the health care system, CMS has set a goal that 100 percent of people with Traditional Medicare will be part of an accountable care relationship by 2030.”
“We are encouraged and inspired by five consecutive years of savings and quality improvement,” said Meena Seshamani, M.D., Ph.D., CMS Deputy Administrator and Director of the Center for Medicare. “Learnings from the Shared Savings Program can and should be applied across the industry, driving higher quality care system-wide. CMS looks forward to continually improving the program, expanding the reach of participating ACOs and addressing critical health disparities across the country.”
The press release went on to note that, “Earlier this year, in the Calendar Year (CY) 2023 Physician Fee Schedule proposed rule, CMS proposed changes to the Medicare Shared Savings Program that would promote participation among health care providers, especially in rural and underserved areas, helping to grow this successful program to improve access to ACOs for more people with Medicare. In particular, CMS is proposing to incorporate advance payments to certain new ACOs in rural and underserved communities that could be used to address social needs, one of the first times Traditional Medicare payments would be permitted for such uses. CMS is also proposing that smaller ACOs have more time to transition to downside risk, and a health equity adjustment to an ACO’s quality performance score that would reward excellent care delivered to underserved communities. In addition, CMS is proposing benchmark adjustments to encourage more ACOs to join the program and to maintain participation amongst current ACOs. If finalized, these improvements and others would strengthen and grow the successful program, representing some of the most significant reforms since the program was established in 2011. Public comments on the CY 2023 Physician Fee Schedule are due by September 6, 2022.”
Ninety-nine percent of quality benchmarks met
One specific accomplishment that CMS officials touted in particular was around quality; the press release noted that “Nearly all ACOs – 99 percent – reported and met the quality standard required to share in savings under the Shared Savings Program. ACOs had higher mean performance on quality measures compared to other clinician groups not in the program. This includes higher performance for quality measures related to diabetes and blood pressure control; breast cancer and colorectal cancer, and falls risk screening rates; flu vaccination; tobacco screening and smoking cessation; statin therapy for the treatment and prevention of cardiovascular disease. ACOs also had better performance on depression screening and depression remission rates, underscoring how this type of coordinated, whole-person care can improve treatment of behavioral health conditions in ACOs, in helping to achieve the goal of strengthening behavioral health quality in CMS’ Behavioral Health Strategy.”
Financial goals were more elusive. “Approximately 58 percent of participating ACOs earned payments for their performance in 2021,” the press release stated. “The type of ACOs that saw more net savings tended to be low-revenue, meaning they were mainly made up of physicians, included a small hospital, or served rural areas. With $237 per capita in net savings, low-revenue ACOs lead high-revenue ACOs, who had $124 per capita net savings. Those ACOs comprised of 75 percent primary care clinicians or more, saw $281 per capita in net savings compared to $149 per capita in net savings for ACOs with fewer primary care clinicians. These results underscore how important primary care is to the success of the Shared Savings Program and demonstrate how the program supports primary care providers.”
And, “In addition, CMS is working to advance health equity by designing, implementing, and operationalizing policies and programs that support health for all people served by our programs. A health equity analysis of people eligible for assignment to ACOs in the 2021 performance year demonstrated that lower income individuals or members of racial or ethnic communities appeared to represent a disproportionately smaller share of the Medicare population assigned to ACOs. In line with the Biden-Harris administration’s commitment to advancing racial equity and support for underserved communities, CMS proposed updates in the CY 2023 Physician Fee Schedule proposed rule, which are designed to improve access to ACOs in underserved communities.”
The leaders of NAACOS, the Washington, D.C.-based National Association of ACOs, the leading nationwide association of ACO leaders, posted a press release to its homepage, which began thus: “Medicare's largest alternative payment model continues to produce consistent and significant annual savings, while also continuing to provide high-quality care, as shown by performance data released today by the Centers for Medicare & Medicaid Services (CMS). The Medicare Shared Savings Program, the accountable care organization (ACO) model that served 11 million seniors in 2021, collectively saved Medicare $3.6 billion last year, and $1.6 billion after accounting for shared savings payments. Of the 475 ACOs, 81 percent achieved savings to Medicare with 56 percent achieving shared savings.”
"Today's results again demonstrates that ACOs drive us towards a health care system that delivers affordable, equitable, high-quality, person-centered care" said NAACOS president and CEO Clif Gaus, Sc.D., in a statement contained in that press release. "Eight years of continued strong performance with the positive proposed changes to the program included in the physician fee schedule sets the stage for significant growth in accountable care.”
The NAACOS press release went on to state that “ACOs provide an alternative to the fragmented fee-for-service system by holding groups of doctors, hospitals, and other providers accountable for the cost and quality of a defined set of patients. They earn the right to share with Medicare savings generated if certain spending and quality metrics are met. Results for all 2021 Shared Savings Program ACOs, which compare the year's spending to pre-set targets, are available in an online public use data file. In 2021, 477 ACOs voluntarily participated in the Shared Savings Program. These results are particularly notable as 2021 was a year in which providers were still actively responding to the COVID-19 public health emergency. ACOs were valuable assets in managing patient care given their accountability to long-term patient care and outcomes. ACOs were proactive in their outreach to high-risk patients to keep them healthy, quickly established telehealth and remote monitoring capabilities to continue to provide care, and effectively managed home visits and post-acute care to reduce COVID transmission.”
NAACOS’s leaders also noted the following, which they considered key points from the results announced by CMS on Tuesday:
> $357 in gross savings per beneficiary
> 76 percent of shared savings only ACOs produced gross savings with an average savings rate of 2.5 percent
> 89 percent of at-risk ACOS produced gross savings with an average savings rate of 4.7 percent
And, the NAACOS press release concluded, “The Administration has proposed significant changes to MSSP that will help grow the program. These changes will attract providers who serve vulnerable populations. We also need Congress to act to keep momentum in alternative payment models. NAACOS supports the Value in Health Care Act (H.R. 4587), which would extend payment incentives for risk-bearing ACOs. The $3.6 billion in savings achieved in 2021 far exceeds the estimated $700-900 million in advanced APM bonuses expected to be paid. These incentives have been critical in helping clinicians cover the investment costs of moving to new payment models.”
ACO leaders tout their successes
Some ACO leaders were quick to boast of their successes in the program. One such organization was Community Care of Brooklyn IPA, a consortium led by Maimonides Medical Center in Brooklyn, New York. In a press release posted to the organization’s website immediately after the CMS announcement, the leaders of CCB IPA announced that “Community Care of Brooklyn IPA, Inc. today announced total savings of $11,499,388 in 2021, marking another year of strong performance in the Medicare Shared Savings Program (MSSP). The group’s ability to meet both quality goals and spending targets in 2021 resulted in shared savings of more than $1,200 per Medicare beneficiary relative to CMS targets. Shared savings will be reinvested in CCB IPA’s network of partners who together serve nearly 10,000 fee-for-service Medicare beneficiaries across Brooklyn.”
CCB IPA’s press release continued, “Almost 45 percent of the Medicare beneficiaries attributed to CCB IPA during 2021 were dually eligible for Medicaid; for ACOs overall, approximately 9 percent of all beneficiaries are dually eligible. ‘As an organization focused specifically on Brooklyn, CCB IPA and its network of dedicated partners serve an incredibly diverse and often complex group of patients, evidenced by the disproportionate number of dually-eligible patients attributed to our ACO,’ said LaRay Brown, CCB IPA Board Chair and CEO of One Brooklyn Health System. CCB IPA’s 2021 quality score of 83.21 percent reflects findings from chart reviews, performance on certain claims-based measures, and a CAHPS survey conducted to measure patient satisfaction,” the organization noted. “Having met quality goals and achieved savings, CCB IPA will receive a shared savings payment for distribution to 65 eligible partner organizations and physician practices and for use to offset operating costs. CCB IPA’s network of Participants includes hospitals, FQHCs, ambulatory care programs, and private practices serving diverse and historically disadvantaged communities across Brooklyn.”
“These results demonstrate the commitment of our network of Brooklyn-based providers and the strong foundation we have built to enhance access to needed services, improve quality, and reduce the total cost of care for our patients,” said Caroline Greene, CCB IPA Executive Director and Senior VP for Population Health at Maimonides Medical Center. “We look forward to once again putting the shared savings earned under the MSSP to work in ways that will be of value to our partners and the Medicare beneficiaries they serve.”
Another organization that was quick to announce its success in the program was the Dallas-based Signify Health, which describes itself as “a leading value-based healthcare platform enabled by advanced analytics, technology, and nationwide healthcare networks.” In a press release posted to their website, Signify Health’s leaders announced on Tuesday that “Signify Health, Inc. (NYSE: SGFY), a leading value-based healthcare platform enabled by advanced analytics, technology, and nationwide healthcare networks, today announced that its collaborative accountable care organizations (ACOs) generated more than $138 million in gross savings in 2021. As a result of their strong performance in the Medicare Shared Savings Program, community hospitals and their affiliated physicians earned more than $59 million in shared savings payments. The Company also announced that it has surpassed its target for new ACO bookings in 2023 due to the strong performance and the combined capabilities of Signify Health and Caravan Health.
“These impressive results confirm what we have learned through many years managing outcomes-based payment models – our dedicated population health management leads to quality care while saving money for Medicare,” said Kyle Armbrester, Signify Health CEO, in a statement contained in the press release. “Our approach and track record has resonated with our clients, allowing us to achieve record ACO sales for 2023 and to surpass 700,000 lives under management in 2023, with nearly 70% of attributed lives expected to be in Enhanced tracks. I’m excited to bring Signify’s in-home capabilities to these new clients in the coming months.”
The press release went on to state that “Signify Health’s success-based pricing model, with no upfront fees, effectively minimizes downside risk and has resulted in all Collaborative ACOs earning MIPS scores of 100% and the maximum positive payment adjustment. MIPS, the Centers for Medicare & Medicaid Services’ value-based measurement program, adjusts Medicare payment rates based on healthcare quality and outcomes. In 2022, Signify aligned with more than 29,000 providers across more than 40 states, representing more than 500,000 covered lives. Provider organizations participating in Signify’s Collaborative ACOs include health systems, integrated delivery networks, rural and community hospitals, and independent practices. Signify is building on its success with a suite of new services in 2023, including in-home capabilities, Return to Home to support patient care transitions, and analytic enhancements to help providers solve patient problems at the point-of- care. In March 2022, Signify Health acquired Caravan Health, a leader in guiding ACOs to success with client results that have historically led the nation in earned shared savings and MIPS scores. The acquisition resulted in one of the largest national networks of providers engaged in value-based payment models, with the goal to excel in population health management and value-based payment programs.”
