Gauging ACO success in 2019

The number of ACO contracts has decreased slightly, but the number of individuals covered by those ACOs has increased from 2018 to 2019. The Centers for Medicare & Medicaid Services (CMS) recently released data on Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) for Performance Year 2019 that show some changes in provider participation as of July 1, 2019. Experts writing for Health Affairs analyzed the results of the report, gauging the level of ACO success during the reporting period.

MSSP “facilitates coordination among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing the growth in health care costs. Eligible providers, hospitals, and suppliers may apply to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO).” In addition, CMS has created a new ACO program, Pathways to Success, which may also have impacted the success of ACOs in 2019.

The Health Affairs analysts state that there has been an increase in the number of physician-led ACOs “and they have moved to downside risk at a slightly higher rate than ACOs with hospitals.” The total number of ACOs has decreased while the number of lives impacted has increased during the performance year. Of the 995 ACOs currently active, 425 (43 percent) are physician-led, compared to 274 hospital-led and 294 jointly led.

Previous estimates speculated that about half of ACOs would exit MSSP, the largest ACO program, with the rollout of the Pathways to Success program. However, in reality only a modest number left and 41 ACOs joined the program in July 2019. Higher dropout rates were noted for physician-led ACOs than for hospital-led and large ACOs.

Health Affairs also reports that “so far this year in 2019, there was a modest decrease in the proportion of downside risk contacts by small organizations, and conversely there was a modest increase in proportion of downside risk contacts by large organizations.” The analysts stated that “The acceleration of ACOs accepting downside risk beginning in 2019 could represent the MSSP policy changes taking effect and deterring smaller organizations from joining or staying based on mandatory downside risk.”