There’s been interesting news lately in the accountable care organization (ACO) world. CMS recently announced that participants in the ACO program have declined since 2018. This decline comes after the agency overhauled the program. Additionally, according to a watchdog report, CMS needs to review how changes have impacted their ability to coordinate care.
CMS Announcement
CMS announced that 518 ACOs are part of the program as of July 1, a decline from 561 ACOs that participated in 2018. In a blog post published in Health Affairs, CMS Administrator Seema Verma announced the newest enrollment figures in the Medicare ACO program since the agency overhauled the program late last year. Medicare ACOs will now be required to take on downside risk sooner in the program, which analysts said would likely lead to participation drops. The CMS made the changes as ACOs continued to hold off taking on downside risk years into the program.
The new data have the National Association of ACOs worried about whether the decline is an anomaly or the start of a trend thanks to major changes to the Medicare Shared Savings Program (MSSP). “This slowing growth will shrink the pool of future, risk-taking ACOs, which CMS should concern itself with,” Clif Gaus, CEO of the National Association of ACOs, said in a prepared statement.
In addition to the low number of ACOs signing up, the rate of ACOs leaving the program has ramped up in 2019. About 40% of ACOs who had contracts at the end of 2018 decided to not apply to participate in the new program, which is higher than the usual churn rate of 30%.
OIG Report
According to the HHS’ Office of Inspector General (OIG), the Trump administration needs to review how major changes to ACOs have impacted their ability to coordinate value-based care. OIG said in a report that ACOs have reported successful strategies to lower Medicare spending. But the CMS must do better in sharing such strategies in addition to performing a review.
“CMS should conduct this review to determine the extent to which ACOs are participating in the program and the extent to which ACOs are reducing spending and improving quality,” the report said.
OIG made seven recommendations to CMS, emphasizing how they would support efforts to reduce unnecessary spending and improve quality of care. OIG recommends CMS: (1) review the impact of programmatic changes on ACOs’ ability to promote value-based care; (2) expand efforts to share information about strategies that reduce spending and improve quality among ACOs and more widely with the public; (3) adopt outcome-based measures and better align measures across programs; (4) assess and share information about ACOs’ use of the skilled nursing facility (SNF) 3-day rule waiver and apply these results when making changes to the Shared Savings Program or other programs; (5) identify and share information about strategies that integrate physical and behavioral health services and address social determinants of health; (6) identify and share information about strategies that encourage patients to share behavioral health data; and (7) prioritize ACO referrals of potential fraud, waste, and abuse.