Editor’s Notes: Good ACO News, Coming at a Key Moment
The news coming out of the Centers for Medicare & Medicaid Services (CMS) this week was all good. What might that mean in the context of an uncertain and complex political landscape around healthcare generally and around value-based contracting more specifically?
Well, to begin with, the news coming out of the federal government on Oct. 29 was excellent; on Tuesday, senior officials at CMS were able to announce record net savings for the Medicare Shared Savings Program (MSSP) on Oct. 29—a total of more than $2.1 billion in 2023, along with $3.1 billion in performance payments for accountable care organizations (ACOs) participating in the program.
The agency posted a press release to its website on Tuesday afternoon that began thus: “The Centers for Medicare & Medicaid Services (CMS) announced today that the Medicare Shared Savings Program (Shared Savings Program) continues to save Medicare money while supporting high-quality care. The Shared Savings Program yielded more than $2.1 billion in net savings in 2023 — the largest savings in the Shared Savings Program’s history. In addition, Shared Savings Program Accountable Care Organizations (ACOs) are providing higher-quality care and supporting policies CMS has adopted to enhance primary care, expand access to accountable care to underserved communities, and prioritize quality care for common chronic conditions.”
The press release went on to state that, “In 2023, ACOs in the Shared Savings Program earned shared savings payments (also known as performance payments) totaling $3.1 billion, the highest since the program’s inception more than 10 years ago. In addition, ACOs scored better on many quality measures than other types of physician groups and continued to demonstrate quality improvement. ACOs led by primary care clinicians had significantly higher net per capita savings than ACOs with a smaller proportion of primary care clinicians. These results continue to underscore how important primary care is to the success of the Shared Savings Program.”
And it quoted Chiquita Brooks-LaSure, CMS Administrator, as saying that “Accountable Care Organizations in the Medicare Shared Savings Program continue to deliver high-quality health care for people with Medicare and meaningful savings for the Medicare program. CMS continues to improve the Medicare Shared Savings Program for the future so that providers in Accountable Care Organizations are able to deliver coordinated, high-quality, affordable, equitable, person-centered care to people with Medicare,” Brooks-LaSure added.
All of this news was good right on its face; but some involved in the ACO world pointed to additional positive elements below the top headlines. For example, on that same day, in a LinkedIn post, Jason Jobes, senior vice president of solutions at the Austin, Tex.-based Norwood consulting firm, noted, among other things, that, among the 453 ACOs whose data was released, fully 69 percent achieved savings last year, with $3.08 billion in shared savings payments made to the ACOs that had achieved savings for CMS.
What’s more, Jobes noted, the top ten organizations with the most savings racked up $631 million, or 20 percent of all savings. Also, significantly, 78 percent of the largest 100 ACOs by size achieved savings, while only 64 percent of the smallest ACOs were able to do so.
Clearly, larger organizations with strong operating and care management infrastructures, are doing the best in the MSSP program.
Meanwhile, Farzad Mostashari, M.D., the co-founder and CEO of the Bethesda, Md.-based Aledade, a physician enablement company, focused on this, in tweets on X: “As CMS reports, ‘ACOs led by primary care clinicians had significantly higher net per capita savings than ACOs with a smaller proportion of primary care clinicians,” he noted in a post on X (formerly Twitter) on Oct. 29. And he added, “Another myth: to succeed in value-based care, you wouldn't listen to what patients want. Aledade Tri-State (9-percent savings rate) was the highest -rated ACO in the country by patients for shared decision making. The second highest savings ACO in Aledade,” he wrote, “was our PA MSSP ACO (15.4-percent savings).”
Also on Oct. 29, leaders at the Washington, D.C.-based APG (America’s Physician Groups) posted a press release to their website on Oct. 29 touting primary care-focused physician groups’ contribution to the savings and quality results referenced by CMS. The press release began thus: “Physician-led organizations focused on primary care – including multiple member organizations of America’s Physician Groups (APG) – continue to produce top results in the Medicare Shared Savings Program (MSSP), based on 2023 results released today by the Centers for Medicare & Medicaid Services (CMS). These primary care-focused organizations earned “significantly higher net per capita savings than ACOs with a smaller proportion of primary care clinicians,” the agency said in a news release, while also earning high quality scores,” the association noted.
The press release continued in that vein, “A pertinent example: APG member organizations Austin Regional Clinic (ARC) and the Ascension Seton Health Alliance, ACO partners that have scored shared savings every year for the past decade and are once again among top performers. ARC’s president and CEO, Anas Daghestani, MD, also chairs APG’s Board of Directors. APG is now analyzing the announced MSSP results and will shortly issue a more complete list of its high-performing members who are MSSP participants.”
What does all this mean? Even as we wait for additional releases of data, both from CMS and from some of the more successful ACOs in the MSSP program, it seems clear that operational concentration, and yes, sheer size, are among what seem to be critical success factors right now in the MSSP program. And, as the APG and Aledade leaders are emphasizing, a strong focus on primary care also appears to be a major success factor.
Most of all, it seems clear that the MSSP, for all its challenges, is doable. Many provider leaders assert that success in the MSSP becomes progressively more difficult over time, as an organization meets savings and quality goals, and essentially, is challenged to do better year over year. That factor remains to be analyzed longer-term to determine whether the complain from providers is legitimate or not. But it’s clear that real, sustained success remains possible in the program, and in a moment in which the landscape around the program could shift with the upcoming presidential and congressional elections, those highly invested in the success of the MSSP and of the ACO concept in general, can feel validated by these just-announced results.
