Major government ACOs to cover 13.2M people this year

Dive Brief:

Three of the government’s main accountable care programs will cover more than 13.2 million people enrolled in Medicare this year, the CMS announced on Tuesday, as it works to expand the number of beneficiaries in the value-based arrangements.
More than 704,000 physicians and other organizations will participate in one of the agency’s value-based initiatives — the Medicare Shared Savings Program along with two CMS innovation center accountable care models, ACO REACH and Kidney Care Choices. More than 1,450 hospitals are in ACOs.
ACOs and value-based care advocates cheered the news, with the National Association of ACOs calling 2023 a “turning point” for ACO growth.

Dive Insight:

The CMS is making progress on its goal to have all traditional Medicare beneficiaries in accountable care arrangements by 2030, according to new agency data released Tuesday.

In 2023, 10.9 million beneficiaries are being cared for in MSSP ACOs, while 2.1 million are being cared for by REACH ACOs.

MSSP, which was established by the Affordable Care Act, is the largest accountable care initiative in the U.S. Participation in MSSP peaked in 2018 with 561 ACOs, but has fallen amid CMS rules that made involvement riskier financially. Now there are 456 ACOs in MSSP.

The CMS said that, though MSSP experienced a decrease in ACOs and assigned beneficiaries for 2023, the policies finalized in a recent pay rule should grow participation next year and beyond. Policies include giving providers upfront investment dollars that are paid back through shared savings, a slower path to financial risk and more realistic policies around spending targets, according to NAACOs.

Meanwhile, ACO REACH now has 132 participants, up from 99 last year.

In ACO REACH, doctors can accept either full or partial capitation as payment, with the goal of coordinating primary and specialty care for patients while giving access to additional benefits like telehealth visits. The model has a new requirement for providers to implement a health equity plan and extend access in underserved communities, along with guardrails to increase provider governance.

“We expect 2023 to be a turning point for ACOs and growth in participation to really accelerate in 2024 thanks to CMS leadership,” NAACOs president and CEO Clif Gaus said in a statement on the data. “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.”