CMS Welcomes New Medicare Shared Savings Program (Shared Savings Program) Participants
On January 11, 2016, the Centers for Medicare & Medicaid Services (CMS) announced the selection of 100 new Accountable Care Organizations (ACOs) and 147 renewing ACOs that are joining or continuing their participation in the Medicare Shared Savings Program (Shared Savings Program) for the 2016 performance year, providing Medicare beneficiaries with access to high-quality, coordinated care across the United States. That brings the total of Shared Savings Program ACOs to 434 serving over 7.7 million Medicare fee-for-service beneficiaries.
Since ACOs first began participating in the program in early 2012, thousands of health care providers have signed on to participate in the program, working together to provide better care to Medicare’s seniors and people with disabilities. The new and renewing ACOs will bring approximately 15,000 additional physicians into the ACO program starting January 1, 2016, for a total of over 180,000 participating physicians and other practitioners.
We have encouraged ACOs to progress along the performance-based continuum and made program improvements to incentivize participation in performance-based risk arrangements. In 2016, 22 ACOs will be participating in performance-based risk tracks, which is a significant increase from the current number of performance-based risk ACOs.
The Shared Savings Program continues to draw support from all regions of the country, including continued strong interest from rural areas with the launch of over 54 new ACOs serving Medicare beneficiaries in rural areas. Over one-half of our new ACOs reported that they include rural providers in their ACO. Overall, physician and practitioner networks continue to be the most prominent type of ACO in the program.
Background on the Shared Savings Program
Section 3022 of the Affordable Care Act added a new section 1899 to the Social Security Act that requires the Secretary to establish the Shared Savings Program. The program is intended to encourage physicians and other providers of Medicare-covered services and supplies (e.g., hospitals and others involved in patient care), to create a new type of health care entity, an ACO, that agrees to be held accountable for improving the health and experience of care for the Medicare fee-for-service beneficiaries assigned to the ACO, while reducing the rate of growth in health care spending.
In June 2015, CMS published a new final rule in the Federal Register. The new final rule addresses changes to the Shared Savings Program and improves the program in a number of areas, including but not limited to:
- Creates a new Track 3, based on some of the successful features of the Pioneer ACO Model, which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;
- Streamlines the data sharing between CMS and ACOs, helping ACOs more easily access data on their patients in a secure way for quality improvement and care coordination that can drive critical improvements in beneficiaries’ care;
- Establishes a waiver of the 3-day stay Skilled Nursing Facility (SNF) rule for certain beneficiaries that are prospectively assigned to ACOs under Track 3; and
- Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings, and announces CMS’ intent to propose further improvements to the benchmarking methodology.
ACOs continue to show promising results. Last fall, CMS released the 2014 quality and financial performance results for ACOs who started the program in 2012, 2013, and 2014. Ninety-two Shared Savings Program ACOs held spending $806 million below their targets and earned performance payments of more than $341 million as their share of program savings. The results showed that ACOS with more experience in the program were more likely to generate shared savings. The results also showed that ACOs that quality reported in both 2013 and 2014 improved on 27 of the 33 quality measures, including patients’ ratings of clinicians’ communication, beneficiaries’ rating of their doctors, screening for tobacco use and cessation, screening for high blood pressure, and Electronic Health Record use. ACOs also outperformed group practices on 18 out of 22 measures reported quality measures.
More information about all ACO initiatives at CMS can be found at http://www.cms.gov/aco.
More information about the Shared Savings Program can be found at http://www.cms.hhs.gov/sharedsavingsprogram/.
Links to the statute, regulations, and guidance regarding the final rule, including the guidance issued by the federal agencies listed above can be found at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Statutes-Regulations-Guidance.html.
For a list of the 247 new and renewing ACOs announced today, visit : https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/News-and-Updates.html.