Taking stock of a decade of Medicare ACOs 

In this week’s graphic, we showcase recent data from Health Affairs highlighting the progress made by the Centers for Medicare and Medicaid Services’ (CMS) flagship value-based payment initiative, the Medicare Shared Savings Program (MSSP). Ten years into the program, a majority of MSSP accountable care organizations (ACOs) have now adopted downside risk, after a slow start that was accelerated by CMS’s 2018 Pathways to Success program update. With more ACOs in downside risk, over 60 percent of program participants received shared savings bonuses in 2022, as MSSP ACOs with two-sided risk are twice as likely as ones with upside-only risk to receive a bonus. Beyond taking downside risk, the highest-performing ACOs in the program have been smaller, physician-only ACOs with relatively more primary care doctors and fewer specialists. While the MSSP program has seen improved growth and savings coming out of the pandemic, the $1.8B in Medicare savings that it generated in 2022 represents only 0.2 percent of total Medicare spending last year.