ACOs to receive $20M in advance investment payments

In 2024, 50 accountable care organizations are new to the Medicare Shared Savings Program (MSSP) and 71 ACOs renewed participation, according to new numbers released by the Centers for Medicare & Medicaid Services (CMS) Monday.

The total number of participants now stands at 480 ACO programs, with 245 organizations continuing in ACO REACH and the Kidney Care Choices (KCC), two types of CMS Innovation Center models. More than 634,000 providers and organizations serve nearly 11 million people in traditional Medicare.

In 2022, 483 ACOs were participating in MSSP, showing a lack of overall growth in program participation.

The ACO REACH Model targets access to underserved populations, particularly in rural areas, while the KCC Model helps those with chronic kidney disease and end-stage renal disease.

Of 19 new ACOs in the MSSP, they will receive more than $20 million as part of a payment option through advance investment payments (AIPs) for aiding underserved populations. ACOs that receive AIPs must invest in "health care infrastructure, staffing and providing accountable care for underserved beneficiaries," according to a press release. This can look like hiring community health workers, using health assessment and screening tools, or implementing case management systems and electronic quality reporting.

Because of ACOs receiving AIPs, care is delivered to people in traditional Medicare in 9,032 federally qualified health centers, rural health clinics and critical access hospitals, an increase of 27% from 2023.

“One of CMS’ top priorities is to expand access to quality, affordable health coverage and care,” said CMS Administrator Chiquita Brooks-LaSure in a statement. “Accountable care initiatives—which give more tools to health care providers to deliver better care and help people receive more coordinated care—through programs like the Medicare Shared Savings Program and the Innovation Center accountable care initiatives are critical to achieving this vision.”

In 2024, there are approximately 13.7 million people in traditional Medicare aligned to an ACO, equal to a 3% increase since 2023, the news release said.

ACO REACH now has 122 members, nearly triple the number of members in 2021. The number of providers jumped from 173,004 to 15,744. The KCC Model has more than 9,227 participating healthcare providers and organizations, a 10% increase from 2023, serving 282,335 people with Medicare.

National Association of ACOs (NAACOS) President and CEO Clif Gaus said in a statement shared with Fierce Healthcare that he is "happy to see growth" but that "more work must be done" if CMS will have patients in accountable care relationships by 2030. He said certain policies would bring new participants into the fold.

"This includes correcting the benchmark ratchet that will make it more difficult for ACOs to create sustainable savings, improving quality reporting requirements to make it less burdensome for ACOs, updating patient engagement requirements, and leveraging MSSP as an innovation platform with hybrid primary care payments and more options for risk," said Gaus.

Earlier this month, NAACOS sent a letter to CMS. In it, the organization expressed worry that MSSP needs stronger financial incentives than fee-for-service or Medicare Advantage.

"While new growth is also essential, we are concerned that the current environment could lead to a retreat from the model," said Gaus in the letter. He noted that FFS Medicare is a more predictable revenue stream and that MSSP participants will soon have new contract agreements that lower benchmarks.

He also called for the savings achieved through MSSP to reinvest in a program that has remained similar over time, among other asks.

CMS said previous ACO model tests, like the Pioneer ACO Model and the Medicare ACO Track 1+ Model, were incorporated into the MSSP.

“The new advance investment payments will enable health care providers in rural and other underserved areas to build the staffing, infrastructure, and care delivery improvements they need to succeed as ACOs providing high quality, equitable, accountable care to their communities,” said Meena Seshamani, M.D., deputy administrator and director of the Center for Medicare. “Everyone deserves access to the type of whole-person care delivered by ACOs.”