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For Providers

Find information on what the Shared Savings Program means for health care providers and suppliers.

Shared Savings Program and Providers

Participation in a Shared Savings Program Accountable Care Organization (ACO) creates incentives for health care providers to work together to treat an individual patient across care settings, including doctor’s offices, hospitals, and long-term care facilities.

For more information on Shared Savings Program ACOs, see About the Program.

ACO Providers and Suppliers

Eligible ACO providers and suppliers that may participate in the Shared Savings Program include:

  • ACO professionals in group practice arrangements
  • Networks of individual practices of ACO professionals
  • Partnerships or joint venture arrangements between hospitals and ACO professionals
  • Hospitals employing ACO professionals
  • Critical Access Hospitals (CAHs)
  • Federally Qualified Health Centers (FQHCs)
  • Rural Health Clinics (RHCs)

 

Care Coordination

Health care providers have reported that a lack of information is a barrier to improving care coordination. While they may know about the services they provide to the beneficiary, they often do not know about all the services the beneficiary receives from other health care providers.

To better treat patients and to coordinate their care, Shared Savings Program ACOs may request Medicare claims information about their patients from CMS.

 

Provider Participation

To participate in the Shared Savings Program, Medicare-enrolled providers and suppliers must form or join an ACO, and the ACO must apply to the Shared Savings Program. Providers and suppliers may contact other ACO participants in the region, state, or national professional associations to investigate opportunities. ACOs must have at least 5,000 Medicare fee-for-service (FFS) beneficiaries assigned to their ACO in each of the benchmark years to be eligible for participation in the Shared Savings Program.

  • For Shared Savings Program ACO locations and contact information, see Program Data.
  • For more information on eligibility criteria, see Program Statutes & Regulations.
  • Frequently asked questions about affiliating with an ACO as an “Other Entity,” instead of an ACO participant.

Exclusivity Rule

Within the Shared Savings Program:

Any ACO participant, as identified by the taxpayer identification number (TIN), that has a specialty used in assignment (see 45 CFR 425.402), and bills Medicare for primary care services must be exclusive to a single Shared Savings Program ACO. However, individual practitioners, identified by individual National Provider Identifiers (NPIs), are free to participate in multiple ACOs if they bill under several different TINs.

Among Medicare shared savings initiatives:

During a performance year, a Medicare-enrolled TIN can participate in only one shared savings initiative, including certain CMS Innovation Center initiatives (see list below).

 

Program Intersection

There are several Medicare initiatives that aim to promote quality improvement while lowering the growth in health care expenditures. Although these programs are separate and distinct, they interact in key areas. The following programs intersect with the Shared Savings Program.

Quality Payment Program

The Quality Payment Program improves Medicare by helping providers focus on care quality and the one thing that matters most—making patients healthier. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, which threatened clinicians participating in Medicare with potential payment cliffs for 13 years.

The Quality Payment Program has two paths:

  1. Advanced Alternative Payment Models (APMs): Includes Shared Savings Program Track 2, Track 3, and the Medicare ACO Track 1+ Model.
  2. Merit-Based Incentive Payment System (MIPS): Includes Shared Savings Program Track 1.

To learn more about Quality Payment Program and Shared Savings Program interaction, see the Quality Payment Program Resource Library webpage.

Other CMS Innovation Center Initiatives

Shared Savings Initiatives

ACO participants cannot participate in multiple Medicare initiatives involving shared savings, including:

  • Next Generation ACO Model
  • Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model
  • Independence at Home Demonstration with a shared savings arrangement (ACA Sec. 3024)
  • Multi-Payer Advanced Primary Care Practice Demonstration

Medicare and the CMS Innovation Center may introduce additional programs, demonstrations, or models with a Medicare shared savings component in the future.

Non-Shared Savings Initiatives

Shared Savings Program ACOs can participate in CMS Innovation Center initiatives that do not involve shared savings. These include:

  • Financial Alignment Initiative
  • Comprehensive Primary Care Plus (CPC+) Model
  • Bundled Payments for Care Improvement (BPCI) Initiative

For a complete list of CMS Innovation Center models and resources for program overlap, see the CMS Innovation Center website.

 

Find Out More

Providers and suppliers that are aligned to a Shared Savings Program ACO should contact their ACO for more specific information on participation in the program.

For general information on provider participation in the Shared Savings Program, see:

 

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