Number of ACOs increases modestly to 483 for 2022, which advocates say should be wake-up call

The number of accountable care organizations participating in the Medicare Shared Savings Program (MSSP) modestly increased to 483 this year compared with 477 for 2021, sparking new worries from advocates over the future of the program.

The Centers for Medicare & Medicaid Services released new figures Wednesday that show the patient population being served by ACOs has slightly grown. The new data come as the Biden administration released a strategic refresh last year for its payment models with the intent of getting every Medicare beneficiary in an accountable care relationship by 2030.

“With one in every five healthcare dollars paid by Medicare, we can strengthen and transform our healthcare system,” said CMS Administrator Chiquita Brooks-LaSure in a statement. “Accountable care organizations present an invaluable opportunity to move Medicare toward person-centered care.”

CMS announced that 66 new ACOs were joining the program this year and that 140 existing ACOs renewed their membership. This brings the total number of ACOs in the MSSP to 483 this year, slightly up from the 477 that were running in 2021.

But the number of beneficiaries who are cared for by an ACO continues to grow.

As of Jan. 1, 2022, more than 11 million Medicare beneficiaries get care from a provider in an MSSP ACO, up by 340,000 (3%) from 2021, CMS' analysis said. 

An ACO agrees to meet certain spending and quality targets. The ACO gets a share of any savings it produces for meeting the targets but must repay Medicare for falling short.

RELATED: ACOs generated $4.1B in gross savings in 2020, nearly double 2019 amount

CMS also found an increase in the number of MSSP ACOs that were on track to qualify as advanced alternative payment models, which gives providers higher financial rewards for delivering cost-efficient and high-quality care.

It found that the number of ACOs in such tracks increased from 34% to 50% for 2022.

“CMS is encouraging healthcare providers to participate in these payment arrangements,” a release on the participation data says.

ACO advocates have been concerned about a decline in overall participation that has been occurring in the MSSP in recent years. There were 517 ACOs participating in 2020, which was up from the 519 that operated in 2019. However, that's down significantly from the 561 that participated in 2018.

The National Association of ACOs (NAACOS) has previously called for CMS to make it easier for organizations to take on financial risk. The group criticized a Trump-era program called “Pathways to Success” that requires ACOs to take on financial risk much earlier in the process.

NAACOS has also called for greater predictability in ACO benchmarks that set the spending and quality targets ACOs must meet to qualify for shared savings as well as increases in such shared savings rates.

NAACOS said in a statement Wednesday that the latest figures were a disappointment.

"With Medicare spending continuing to rise to out-of-control levels and ACOs proving they can effectively increase quality and lower spending, more focus needs to be on increasing the size of ACO programs in traditional Medicare, which needs to happen at levels much greater than what we’ve seen today," said Clif Gaus, NAACOS president and CEO, said in a statement.