Like a fine wine, accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) get better with time. At least, that's what Avalere said in a recent analysis.
ACOs that participated in the MSSP for four years or longer have generated the majority of savings so far, the analysis found, though it notes that the program produced savings for the first time in 2017.
Moreover, experience with the program seems to predict ACOs’ success more accurately than the amount of risk they assume. In fact, assuming downside risk does not seem to predict an ACO’s success, Avalere said.
These results stand in contrast with a rule the Centers for Medicare & Medicaid Services (CMS) released last month that would only allow ACOs to not take on risk for two years.
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“The rule was released before the 2017 results came out, and in the first four years of the program—2013, 2014, 2015 and 2016—Track 1 was costing the program money in the aggregate,” said John Feore, director at Avalere.
"CMS’ rationale was based on the results, I’m sure, that they had to date,” but the 2017 results were a game-changer, he continued.
Moreover, results like these “beg the question of whether the push to downside risk is as important as we thought it was.”
“It takes time to get up and running,” Feore noted. ACOs have to establish a provider network, inform participants, and implement the interventions or care coordination programs that they will use to track their patients, he said.
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Feore discouraged CMS from making the proposed rule a reality.
“Switching from six years of one-side risk to two could cause fewer ACOs to join the program, and some ACOs that may have been successful, given the time,” to drop out, he said.
These results echo other statements and findings.
A report (PDF) released by the Office of the Inspector General at the Department of Health and Human Services last year similarly found that ACOs perform better over time. Further, the National Association of ACOs (NAACOs) has said forcing participants to take on downside risk will discourage participation in the program as well.