ACO sign-ups for 2024 are underway. Policy changes have helped, but more work is needed, experts say

Phase 1 enrollment in the Medicare Shared Savings Program (MSSP) for 2024 is currently underway, and recent reforms hold promise in attracting new providers into accountable care.

However, experts say there's still work for the Centers for Medicare & Medicaid Services (CMS) to do. Aisha Pittman, the senior vice president of government affairs at the National Association of ACOs (NAACOS), told Fierce Healthcare the group tends to think about evolving the program in two buckets: what needs to be done to draw in new participants and what is necessary to keep existing ACOs in the program.

For example, a new requirement around reporting clinical quality data could pose a challenge to providers in the program, she said.

"There are a lot of challenges with interoperability that have made this difficult," Pittman said.

In addition, a longer-term concern is how to lure other types of providers, such as specialty care, into ACO models, she said.

"Ultimately, the ACO program is really based on primary care," Pittman said. "How do we get other types of practices into ACOs?"

That said, while challenges remain, CMS has rolled out a number of changes that align with advocacy from NAACOS and other organizations, she said. For 2023, participation in Medicare ACOs grew slightly following multiple reforms aimed at shoring up the program, and CMS said these models will serve more than 13 million beneficiaries this year.

In 2024, providers who are new to MSSP can apply for advanced investment payments, which they can use to build the necessary infrastructure to manage an ACO. Eligible providers would be considered a low revenue ACO, are inexperienced in risk-based models and are on the basic track.

They can receive a lump sum of $250,000 plus quarterly payments that are risk adjusted per member per month.

"I think we're overall hopeful," Pittman said. "We've seen the prior iteration of [the payments] work."

She added that there are NAACOs members that are interested in renewing with the program early, as they can take greater advantage of updates to benchmarking that have rolled out of late.

Pittman said CMS has also made changes to the glide path that could make it easier for new ACOs to adjust to the program. Making the shift to downside risk can be difficult for some providers, she said.

"We don’t want folks to come in and start doing the hard work it takes to redesign care systems and then have to move to risk before they’re ready," Pittman said.