Dive Brief:
- Accountable care organizations in traditional Medicare are prospering, federal regulators said in new data released Monday. However, participation in Medicare’s largest value-based care program has stayed generally the same over the last five years.
- Roughly 13.7 million Medicare patients this year — nearly half of beneficiaries on traditional Medicare — are in accountable care organizations, or ACOs, groups of providers that work together to coordinate patients’ care. That’s a 3% increase from 2023, the CMS said. Similarly, almost 817,000 providers are participating, compared with 700,000 last year.
- Participation in ACOs is important since the organizations have been shown to create better outcomes than non-ACO physician groups, and create savings for Medicare’s trust fund as the program faces rapidly approaching insolvency.
Dive Insight:
The Biden administration’s goal is to bring all 34 million beneficiaries in traditional Medicare into value-based arrangements by 2030. Monday’s data release shows progress to that objective, but stagnant growth in Medicare Shared Savings illustrates the difficulty of making such programs attractive to providers.
Shared Savings, Medicare’s flagship accountable care program, is a value-based care purchasing initiative that aims to link provider payments to cost and quality. This year, 480 groups are participating, covering some 10.8 million patients, the CMS said Monday.
Regulators revamped Shared Savings in 2022 in an attempt to revitalize interest among providers. The CMS added benefits like up-front payments to certain providers and made changes to promote more risk-sharing. Last year, regulators updated Shared Savings again to include more people who receive care from nurse practitioners, physician assistants and clinical nurse specialists, and changed benchmark methodology to encourage ACOs to care for medically complex beneficiaries.
The CMS said it expected those changes to increase participation by roughly 10% to 20%. Yet, regulators have yet to see an increase of that scale.
The number of ACOs in Medicare Shared Savings has trended down since 2018, while covered beneficiaries have plateaued since 2019
The CMS also said on Monday that more providers were participating in programs including Kidney Care Choices, which aims to coordinate care for people with chronic kidney and end-stage renal disease, and ACO Realizing Equity, Accountability and Community Health, or ACO REACH.
ACO REACH aims to improve care for underserved populations, and replaced the government’s prior direct contracting model last year.
The National Association of ACOs, which represents value-based organizations, said it was pleased with the growth in CMS programs.
Yet, “more work must be done,” said NAACOS CEO Clif Gaus in a statement on Monday, including making quality reporting requirements less strenuous for the groups.
