To advance its goal of having 100% of people in traditional Medicare in an accountable care relationship in seven years, the Centers for Medicare and Medicaid Services has announced three initiatives in the Medicare Shared Savings Program and the ACO REACH and Kidney Care Choices models.

More than 700,000 healthcare providers and organizations will participate in at least one of the three initiatives this year, CMS said. These programs are expected to grow and provide care to more than 13.2 million people with Medicare.

WHY THIS MATTERS

The number of accountable care organizations serving Medicare patients will grow slightly in 2023, according to CMS data. 

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, CMS said. 

Participation in the Medicare Shared Savings Program peaked in 2018 with 561 ACOs but fell as CMS released rules that forced ACOs into financial risk faster, according to the National Association of ACOs.

Last year, CMS finalized several changes to MSSP that will encourage providers to join ACOs, NAACOS said. This includes giving up-front investment money that's paid back through shared savings, having a slower path to financial risk and setting more realistic policies around financial spending targets. 

Also last year, the CMS Innovation Center made numerous updates to the ACO Realizing Equity, Access, and Community Health (REACH) Model that increases provider governance, places greater emphasis on health equity and gives additional oversight and patient protections. 

There are now 456 ACOs in the Medicare Shared Savings Program, the country's dominant value-based payment program, while the ACO REACH Model counts 132 participants. 

This year, 67% of Shared Savings Program ACOs are in two-sided risk and 33% are in one-sided risk. Nearly 704,000 physicians and other non-physicians and more than 1,450 hospitals are in ACOs, according to NAACOS. NAACOS said it supports CMS's 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.  

America's Physician Groups has numerous member organizations participating in the ACO REACH Model for 2023. APG president and CEO Susan Dentzer said all model participants achieved 100% compliance with quality metrics and continue to show quality improvements relative to the rest of Medicare.

Dentzer said, "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."

THE LARGER TREND

ACOs are groups of doctors, hospitals and other healthcare providers who collaborate to provide coordinated, high-quality care to their Medicare patients. The goal is to reduce fragmentation between providers in order to avoid unnecessary duplication of services and prevent medical errors.

In February, CMS redesigned the controversial Global and Professional Direct Contracting Model into ACO REACH, focused on health equity.  

Opponents of direct contracting believed it would lead to the privatization of Medicare. Physicians for a National Health Program also opposed ACO REACH as "direct contracting in disguise."

CMS said ACO REACH is the first accountable care model in Medicare to directly address issues related to health equity and access. Participants are held financially accountable for the total health and cost of care. 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.

The ACO REACH Model includes 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 healthcare providers and organizations providing care to an estimated 2.1 million beneficiaries. It has 824 Federally Qualified Health Centers, Rural Health Centers and Critical Access Hospitals participating in 2023 – more than twice the number in 2022.

The Kidney Care Choice 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 delaying the onset of dialysis and increasing access to kidney transplantation. 

For 2023, the model will include 130 KCC entities. The KCC Model will have more than 8,398 participating healthcare providers and organizations, and 249,983 beneficiaries, in 2023. That is an 87% increase in the number of providers and organizations, and a 62% increase in the number of beneficiaries from 2022. A second cohort of the KCC Model increases the geographic reach of the Model into new areas, including North Dakota and South Dakota.

ON THE RECORD

CMS Administrator Chiquita Brooks-LaSure said, "Healthcare 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."

Clif Gaus, president and CEO of NAACOS said, "We expect 2023 to be a turning point for ACOs and growth in participation to really accelerate in 2024 thanks to CMS leadership. 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."

America's Physician Groups president and CEO Susan Dentzer said, "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."
 

Twitter: @SusanJMorse
Email the writer: [email protected]