Officials at the Centers for Medicare and Medicaid Services (CMS) on Jan. 17 announced details of participation in the accountable care organization (ACO) programs sponsored by the Medicare program, as well as announcing some policy goals, changes and emphases. And leaders of national associations whose members have been participating in those ACO programs made announcements themselves regarding progress in savings and outcomes in those programs.
Under the headline “CMS Announces Increase in 2023 in Organizations and Beneficiaries Benefiting from Coordinated Care in Accountable Care Relationships,” and the subhead “Three Innovative Initiatives Will Help CMS Achieve Goal of 100% of Traditional Medicare Beneficiaries in Accountable Care Relationships by 2030,” CMS officials posted their announcement in the form of a press release posted to CMS’s website on Tuesday, Jan. 17.
The press release began thus: “Today, the Centers for Medicare & Medicaid Services (CMS) announced that three innovative accountable care initiatives will grow and provide higher quality care to more than 13.2 million people with Medicare in 2023. More than 700,000 health care providers and organizations will participate in at least one of the three initiatives – the Medicare Shared Savings Program and two CMS Innovation Center accountable care model tests. This growth furthers achieving the CMS’ goal of having all people with Traditional Medicare in an accountable care relationship with their health care provider by 2030.”
“Through the CMS accountable care initiatives and working with our partners, we have made significant progress in addressing our greatest health care challenges,” CMS Administrator Chiquita Brooks-LaSure said in a statement contained in the press release. “Health care providers coming together as Accountable Care Organizations provide high quality and equitable care to people with Medicare while improving the sustainability of the Medicare program.”
The press release went on to note that “Today’s announcement includes three CMS accountable care initiatives: the Medicare Shared Savings Program (Shared Savings Program), the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, and the Kidney Care Choices (KCC) Model. Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who collaborate to provide coordinated, high-quality care to their Medicare patients. The focus of this coordinated care is to ensure that patients get the right care at the right time by reducing fragmentation between providers, which has several benefits, including avoiding unnecessary duplication of services and preventing medical errors.”
Further, the press release stated, “In 2022, CMS published a vision for increasing access to accountable care to bring coordinated, high-quality care to patients by supporting organizations new to value-based care and shared savings to increase participation in ACOs, advancing health equity by expanding the reach of ACOs in underserved communities, and scaling successful features of model tests into the permanent Shared Savings Program.”
The press release noted that “The Shared Savings Program is the largest accountable care initiative in the country and is a permanent program in Medicare that was established by the Affordable Care Act. The Shared Savings Program has 456 ACOs and 10.9 million assigned beneficiaries in 2023. While the Shared Savings Program experienced a decrease in the number of ACOs and assigned beneficiaries for 2023, the policies finalized in the CY 2023 Medicare Physician Fee Schedule final rule are expected to grow participation in the program for 2024 and beyond, when many of the new policies are set to go into effect. These policies are expected to drive growth in participation, particularly in rural and underserved areas, promote equity, and advance alignment across the accountable care initiatives, and increase the number of beneficiaries assigned to ACOs participating in the program by up to four million over the next several years.”
Further, “The ACO REACH Model aims to improve the quality of care for people with Traditional Medicare through better care coordination and by increasing access to accountable care in underserved communities. Innovative features the Model will test include benchmark adjustments to shift payments to better support care for the underserved and enhanced Medicare benefits, including care in the home. For 2023 the ACO REACH Model has 132 ACOs with 131,772 health care providers and organizations providing care to an estimated 2.1 million beneficiaries.”
The press release went on to note that, “Importantly, in 2023, ACO REACH will increase access to accountable care in underserved populations. The ACO REACH Model will have 824 Federally Qualified Health Centers, Rural Health Centers, and Critical Access Hospitals participating in 2023 – more than twice the number in 2022. Increasing the number and reach of ACOs in underserved communities will help close racial and ethnic disparities that have been identified among people with Traditional Medicare in accountable care relationships. Lastly, in 2023 over 55% of REACH ACOs have self-reported as provider organizations.”
And, it added that “The KCC Model focuses on coordinating care for Medicare beneficiaries with chronic kidney disease stages 4 and 5 and end-stage renal disease. In addition to care coordination, the KCC Model focuses on key areas of concern for this population, including delaying the onset of dialysis and increasing access to kidney transplantation so more patients can live fuller and longer lives. For 2023, the model will include 130 KCC entities, which are accountable for the quality and care of their aligned beneficiaries. The KCC Model will have more than 8,398 participating health care providers and organizations and 249,983 beneficiaries in 2023, an 87% increase in the number of providers and organizations, a 62% increase in the number of beneficiaries from 2022, and the second cohort of the KCC Model increases the geographic reach of the Model into new areas, including North Dakota and South Dakota.”
APG and NAACOS respond
That same day, the leaders of America’s Physician Groups (APG) and NAACOS, the National Association of ACOs, responded to the CMS announcement with statements of their own, in the form of press releases posted to their websites. Both associations are based in Washington, D.C.
APG’s leaders said in their press release that “America’s Physician Groups (APG) congratulates its members who are among the 132 organizations participating in 2023 in the Centers for Medicare & Medicaid (CMS) Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. APG also salutes ongoing savings from the model for the nation’s taxpayers, along with better quality outcomes relative to the rest of the Medicare program. Preliminary CMS data, for example, show that average Medicare spending was two percent below the benchmarks set for the Direct Contracting model (now ACO REACH) in the first nine months of 2022. The APG member organizations participating in the ACO REACH Model for 2023 include physician practices affiliated with agilon health; Bloom Healthcare; CareAllies; Castell, an Intermountain Company; CHESS; Collaborative Health Systems; Commonwealth Primary Care ACO; NeueHealth; North East Medical Services; Oak Street Health; OneMedical/Iora Health; Triad Healthcare Network; Reliant Medical Group; UpStream Healthcare; VillageMD; and Wellvana Health.”
“We’re proud that so many of our members are moving forward in the ACO REACH model,” said Susan Dentzer, APG president and CEO said in a statement contained in the association’s press release. “The 2023 performance year will be key for this model, as participants for the first time are held accountable for pursuing health-equity plans to reduce care disparities across racial, ethnic, and other lines.
“We also note that, to date, all model participants have achieved 100 percent compliance with quality metrics, and continue to show quality improvements relative to the rest of Medicare,” Dentzer continued. “New CMS data show that, for the 12-month period that ended June 2022, model participants achieved rates of unplanned admissions for patients with multiple chronic conditions that were lower on a statistically significant basis than across all the rest of Medicare – the traditional fee-for-service program, the Medicare Shared Savings Program, and the Next Generation ACO program as well. This result means that thousands of patients involved in what’s now the ACO REACH model have been spared unnecessary, costly, and debilitating hospital stays for chronic conditions that can be managed well on an outpatient basis, but that in much of the Medicare program often are not.”
APG’s leaders noted that, “In early 2022, the Global and Professional Direct Contracting Model was revised and renamed the ACO REACH Model, and is the first accountable care model in Medicare to directly address issues related to health equity and access. ACO REACH participants will be held financially accountable for the total health and cost of care for the fee-for-service Medicare patients who are attributed to them either through claims or voluntary alignment. The model provides for a holistic, accountable approach to treating Medicare beneficiaries, improving care for those with chronic conditions, addressing their social needs related to health and health care, and achieving greater health equity in the process.”
Meanwhile, NAACOS’s leaders also posted a press release to their website, noting that “The number of accountable care organizations (ACOs) serving Medicare patients will grow slightly in 2023, according to data released today by the Centers for Medicare & Medicaid Services (CMS). With the new participants, there are now 456 ACOs in the Medicare Shared Savings Program, the country’s dominant value-based payment program, while the ACO Realizing Equity, Access, and Community Health (REACH) Model counts 132 participants. The two programs combine to serve 13 million Medicare beneficiaries.”
And the press release included a statement by the association’s president and CEO, Clif Gaus, Sc.D., who said that “NAACOS is encouraged by recent changes to the Shared Savings Program and ACO REACH that should grow participation even more in future years to improve patient care for millions of Medicare beneficiaries. “We expect 2023 to be a turning point for ACOs and growth in participation to really accelerate in 2024 thanks to CMS leadership,” Gaus said. “The interest in high-risk models like ACO REACH should be a signal that CMS needs to include more high-risk options in the Shared Savings Program with many of the features of REACH.”
CMS last year finalized several changes to the Shared Savings Program that will encourage providers to join ACOs, including giving up-front investment money that’s paid back through shared savings, a slower path to financial risk, more realistic policies around financial spending targets, among other changes. Last year, the CMS Innovation Center made numerous updates to the ACO REACH Model that increase provider governance, place greater emphasis on health equity, and giving additional oversight and patient protections.
In 2021, CMS set a goal to have all traditional Medicare beneficiaries in a care relationship with a provider who is accountable for their quality and total cost of care by 2030. It’s a goal NAACOS strongly supports. Participation in the Shared Savings Program peaked in 2018 with 561 ACOs but has fallen since new CMS rules that force ACOs into financial risk faster took effect.”
And NAACOS’s leaders cited what they called “other important numbers from 2023 participation data:
> 10.9 million beneficiaries are cared for by MSSP ACOs and 2.1 million cared for by REACH ACOs
> 67 percent of Shared Savings Program ACOs are in two-sided risk and 33 percent are in one-sided risk
> Nearly 704,000 physicians and other non-physicians are in ACOs
> More than 1,450 hospitals are in ACOs
> There are 24 REACH ACOs in the Professional risk track and 108 in the Global risk track
> There are 105 Standard, 13 New Entrant, and 14 High Needs REACH ACOs"
