CMS: More providers serving as ACOs in 2023 amid new reforms and scrutiny

The number of providers serving as accountable care organizations increased slightly this year thanks to the start of a new advanced model and a slew of reforms meant to reverse a slide in participation.

The Centers for Medicare & Medicaid Services (CMS) released participation data Tuesday for ACOs serving Medicare patients this year across several programs. Overall, ACOs will serve more than 13 million Medicare beneficiaries.

“Through the CMS accountable care initiatives and working with our partners, we have made significant progress in addressing our greatest healthcare challenges,” said CMS Administrator Chiquita Brooks-LaSure in a statement Tuesday. 

This year, there are 456 ACOs serving 10.9 million beneficiaries in the Medicare Shared Savings Program (MSSP), the most popular option available to providers. There are also 132 ACOs serving 2.1 million people in the ACO REACH model, which began its first performance period this year. 

Those figures are a slight improvement overall compared with 2022. Last year, MSSP had 483 ACOs serving 11 million people and ACO REACH, then known as Direct Contracting, had 99. 

CMS also reported that the Kidney Care Choices model, which calls for coordinated care on kidney disease, has 130 participants. 

An ACO in MSSP agrees to meet a series of financial and quality targets for the year and gets any share of savings generated throughout the year. However, if the ACO misses those targets, it must repay Medicare the difference. 

MSSP enables an ACO to decide on the level of risk it seeks to take. CMS reported that 67% of MSSP ACOs are in a two-sided risk model where they get savings but must also repay Medicare for missing the targets, and 33% are in a one-sided model where they get a share of savings but don’t take on financial risk. 

ACO REACH is a model that lets providers take on more financial risk and offers full or partially capitated payments to physicians. The model has a new requirement for providers to create and implement a health equity plan, which calls for the identification and mitigation of social risk factors affecting care. 

“Increasing the number and reach of ACOs in underserved communities will help close racial and ethnic disparities that have been identified among people with traditional Medicare in accountable care relationships,” CMS said.

ACO and value-based care advocates lauded the new participation figures, especially as the number of sign-ups has slowed in recent years after a peak in 2018. 

In 2022, CMS finalized several policy changes meant to spur greater provider interest in ACOs. The agency offered upfront investments to rural providers to help defray the initial costs of participation and installed changes to the calculation of the ACO benchmark, which represents the targets they must meet to qualify for savings. 

“We expect 2023 to be a turning point for ACOs and growth in participation to really accelerate in 2024 thanks to CMS leadership,” said Clif Gaus, president and CEO of the National Association of ACOs, in a statement. 

CMS has a goal to have every Medicare beneficiary in a value-based care relationship by 2030.