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CMS Announces MSSP Savings from 2022

On Aug. 24, CMS officials announced the results of 2022 monetary savings coming out of the Medicare Shared Savings Program (MSSP) for ACOs. Federal healthcare officials praised the MSSP program for its having saved Medicare $1.8 billion in 2022. Among the highlight results: 63 percent ACOs received shared-savings earnings, while physician-owned ACOs did the best at achieving financial savings.

On Aug. 24, officials at the federal Centers for Medicare & Medicaid Services (CMS) announced the results of 2022 monetary savings coming out of the Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs). Federal healthcare officials praised the MSSP program for its having saved Medicare $1.8 billion in 2022. Among the highlight results: 63 percent ACOs participating in the MSSP program received shared-savings earnings, while low-income ACOs, those composed primarily of physicians, did better than did high-volume ACOs, at achieving financial savings. Healthcare associations and leaders responded to the programs results with commentary.

The announcement, which was posted to the agency’s website during midday on Thursday, began thus: “The Centers for Medicare & Medicaid Services (CMS) announced today that the Medicare Shared Savings Program saved money for Medicare while continuing to support high-quality care. Specifically, the program saved Medicare $1.8 billion in 2022 compared to spending targets for the year. This marks the sixth consecutive year the program has generated overall savings and high-quality performance results. This represents the second-highest annual savings accrued for Medicare since the program’s inception more than ten years ago.”

The press release quoted Xavier Becerra, Secretary of Health and Human Services, as stating that “This program has delivered more than $1.8 billion in savings and delivered high-quality health care to millions of people. Just last month, we proposed ways to further grow and expand this successful program, especially in rural and other underserved communities. The Biden-Harris Administration will continue to do everything we can to strengthen Medicare and ensure everyone can access high-quality, affordable health care.”

“The Medicare Shared Savings Program helps millions of people with Medicare experience coordinated health care while also reducing costs for the Medicare program,” CMS Administrator Chiquita Brooks-LaSure said, as quoted in the press release. “CMS will continue to improve the program, and it is exciting to see that Accountable Care Organizations are continuing to be successful in delivering coordinated, high-quality, affordable, equitable, person-centered care.”

The press release noted that “Shared Savings Program Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers who collaborate and provide coordinated, high-quality care to people with Medicare, focusing on delivering the right care at the right time while avoiding unnecessary services and medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, the ACO may be eligible to share in the savings it achieves for the Medicare program (also known as performance payments). This also drives lower health care costs for people with Medicare, who see lower out-of-pocket spending on avoidable health care utilization like emergency department visits because the ACO has better coordinated their care.”

Further, the press release stated, “Over the past decade, the Shared Savings Program has grown into one of the largest value-based purchasing programs in the country. Value-based purchasing programs link provider payments to improved performance by health care providers. This form of payment holds health care providers accountable for both the cost and quality of care they provide, and it attempts to reduce inappropriate care and to

identify and reward the best-performing health care providers. As of January 2023, Shared Savings Program ACOs include over 573,000 participating clinicians who provide care to almost 11 million people with Medicare. Based on the program’s success and opportunities to continually improve value for people with Medicare and the health care system, CMS has set a goal that 100 percent of people with Traditional Medicare will be part of an accountable care relationship by 2030.”

Another official who commented on the results was Meena Seshamani, M.D., Ph.D., CMS Deputy Administrator and Director of the Center for Medicare, stated, “We are encouraged and inspired by six consecutive years of savings and high-quality care, with 2022 being one of the strongest years of performance to date. The Shared Savings Program is Medicare’s permanent, flagship Accountable Care Program, and we look forward to continually improving and growing the program, expanding the reach of participating ACOs, and addressing critical health disparities across the country.”

The press release also referenced that “ACOs had a higher average performance on quality measures they are required to report in order to share in savings compared to other similarly sized clinician groups not in the program. This includes statistically significant higher performance for quality measures related to diabetes and blood pressure control; breast cancer and colorectal cancer screening; tobacco screening and smoking cessation; and depression screening and follow-up. The higher quality performance by ACOs underscores how this type of coordinated, whole-person care can improve treatment of behavioral health conditions, helping to achieve the goals of the CMS’ Behavioral Health Strategy and improve cancer screening rates and prevention in line with the goals of the Cancer Moonshot.”

As for a breakdown of results, the press release went on to say that “Approximately 63 percent of participating ACOs earned payments for their performance in 2022. ACOs that earned more shared savings tended to be low revenue. Low-revenue ACOs are usually ACOs that are mainly made up of physicians and may include a small hospital or serve rural areas. With $228 per capita in net savings, low-revenue ACOs led high-revenue ACOs, who had $140 per capita net savings, and low-revenue ACOs comprised of 75% primary care clinicians or more saw $294 per capita in net savings, more than twice as much. These results underscore how important primary care is to the success of the Shared Savings Program and demonstrate how the program supports primary care providers. As articulated in a recently published article, the Innovation Center continues to explore testing models and features to support Shared Savings Program ACOs in increasing investment in primary care services.

Earlier this year, in the Calendar Year (CY) 2024 Physician Fee Schedule proposed rule, CMS proposed changes to the Medicare Shared Savings Program that would promote participation among health care providers and promote equity, especially in rural and underserved areas, helping to grow this successful program and improve access to coordinated, efficient, and high-quality care provided by ACOs for more people with Medicare. In particular, CMS proposes increasing the number of people receiving high-quality, accountable care by assigning more people who receive care from nurse practitioners, physician assistants, and clinical nurse specialists to ACOs. In addition, CMS proposes changes to the benchmark methodology to encourage participation by ACOs caring for medically complex, high-cost beneficiaries to join the program. These changes would further advance CMS’ overall value-based care strategy of growth, alignment, and equity, building on changes finalized in 2022, which included the establishment of advance investment payments for ACOs in rural and underserved communities, changes to the benchmark methodology, more time to transition to downside risk, and a health equity adjustment that rewards excellent care delivered to underserved communities. Public comments on the CY 2024 Physician Fee Schedule proposed rule are due by September 11, 2023.”

The leaders at NAACOS, the Washington, D.C.-based National Association of ACOs, responded to the results on Thursday, in their own press release, posted to the association’s website. Their press release began thus: “Medicare’s largest alternative payment model produced savings for the ninth straight year, while continuing to provide high-quality care, as shown by performance data released today by the Centers for Medicare & Medicaid Services (CMS). While caring for 10.4 million seniors in 2022, the Medicare Shared Savings Program saved Medicare $4.3 billion, and $1.8 billion after accounting for shared savings and losses. Of the 482 accountable care organizations (ACOs) in 2022, 84 percent achieved savings to Medicare with 63 percent earning shared savings. ACOs have generated more than $21 billion in gross savings for Medicare over the last decade and improved the quality of care for millions of patients. More than 700,000 physicians and other non-physicians participate in Medicare ACOs, caring for more than 13 million beneficiaries today, making it far and away the largest alternative payment model in Medicare,” NAACOS pointed out.

And the association’s press release quoted NAACOS president and CEO Clif Gaus, Sc.D., as stating that, “Every year, the body of data on how ACOs are improving our fragmented health system grows, and this year is no different. ACOs continue to provide more of what patients want and deserve — affordable, high-quality, coordinated, and personalized care.”

The NAACOS press release went on to state that “ACOs and broader value-based care efforts incentivize clinicians to deliver high-quality care while lowering costs to patients and the Medicare program. This includes providing the right care, at the right time, and in the right setting. ACOs hold groups of doctors, hospitals, and other providers accountable for the cost and quality of care for a defined set of patients. They earn the right to share with Medicare savings generated if certain spending and quality metrics are met. Results for all 2022 Shared Savings Program ACOs, which compare the year’s spending to pre-set targets, are available in an online public use data file.”

Further, NAACOS noted, “Today’s data demonstrates how Congress must continue to encourage participation in ACOs and other value-based care models by extending incentive payments for risk-bearing ACOs. NAACOS supports the Value in Health Care Act (H.R. 5013), which would extend incentives that expire at the end of the year. The $4.3 billion in savings achieved in 2022 far exceeds the estimated $644 million paid in incentives this year. These incentives have been critical in helping clinicians cover the investment costs of moving to new payment models.”

And the press release highlighted some key results as presented by CMS:

> $416 in gross savings per beneficiary

> 78 percent of shared savings-only ACOs produced gross savings with an average savings rate of 2.4 percent

> 88 percent of at-risk ACOS produced gross savings with an average savings rate of 4.7 percent

> 304 out of 482, or 63 percent, of ACOs earned shared savings

> ACOs earned $2.5 billion in shared savings payments

APG’s leaders reference “transformative power” of MD-led ACOs

Leaders at APG, America’s Physician Groups, the Washington, D.C.-based association representing physician groups engaged in value-based contracting, also commented on Thursday. The association’s statement was posted to its website on Thursday. It began thus: “Results released today by the Centers for Medicare & Medicaid Services (CMS) showing that the Medicare Shared Savings Program (MSSP) generated $1.8 billion in savings in 2022 further demonstrate the power of physician-led accountable care organizations (ACOs) in transforming the nation’s health care system, America’s Physician Groups (APG), the largest organization representing physicians committed to value-based care, said today.”

“APG welcomes today’s announcement by CMS that the MSSP has again generated large savings for the Medicare program while simultaneously providing high-quality care to millions of older adults,” Susan Dentzer, APG president and CEO, said. “These important results for 2022 underscore the fact that the ACOs that scored the highest per capita savings have been led by physicians. We salute our APG members who were among these high MSSP performers. Their achievements underscore our collective commitment to providing care that is truly accountable for costs and quality.”

APG’s statement went on to note that “APG is a national association representing approximately 360 physician groups with approximately 170,000 physicians providing care to nearly 90 million patients. “The common denominator among our groups is that all are committed to providing value-based health care, through participation in MSSP, the Medicare Advantage Program, and other alternative payment models,” Dentzer said. “We know that when physicians and other providers are given the appropriate incentives and are held accountable for the quality and cost of care they provide, patients will receive better care, experience improved outcomes, avoid unnecessary hospitalizations, and save on out-of-pocket expenses. CMS’s future plans, which we salute, call for building out primary care teams with nurses and other clinicians, who will be able to work with our doctors to provide the person-centered care that all Americans want and deserve.”

The association’s statement went on to note that, “With the 2022 results, the Medicare Shared Savings Program, a cornerstone of the nation’s movement to value-based care, has now demonstrated six consecutive years of savings and high-quality care. Nearly two-thirds of participating ACOs earned shared savings from the government, with those mainly made up of physicians earning the highest per capita net savings. Specifically, ACOs designated “low revenue”—mainly made up of physicians—earned on average $228 per capita in net savings, while high-revenue ACOs, which are typically led by large health systems, experienced $140 per capita net savings.”

And the statement noted pointedly that, “Compared to providers not in ACOs, participating MSSP providers also delivered higher performance on quality measures pertaining to some of the most important clinical conditions affecting older adults, such as diabetes and high blood pressure. ‘These achievements demonstrate the power of the federal government’s pledge that all Medicare beneficiaries—and most Medicaid beneficiaries—should be in accountable relationships with their health care providers by 2030,’ Dentzer said. ‘This accountability— both to patients and to the nation’s taxpayers—is essential to ensuring that health care is affordable, accessible, and equitable for all.’”

Meanwhile, also on Thursday, Farzad Mostashari, M.D., CEO of Aledade, the Washington, D.C.-based consulting firm, posted the following statement to Aledade’s website: ““Today’s Medicare Shared Savings Program (MSSP) results prove that once again MSSP continues to be a success for patients, health care professionals and American taxpayers. After 10 years, one thing is clear – allowing primary care to assume accountability for the total cost and quality of care for their patients works. It works for patients who get access to more informed, more engaged, more proactive primary care. It works for practices who are able to maintain their clinical autonomy and thrive financially. And it works for the Medicare program, which is achieving the promise of better care at lower cost. Our mission at Aledade is to scale these models to as many patients and practices as possible,” Mostashari wrote.

And he went on to state that, “As part of the Aledade network, primary care doctors and their staff have been able to deliver on their promises and provide proactive and preventative care for patients, while generating savings in the process. Since its inception, Aledade has brought in more than $650 million in savings directly to community primary care practices and generated $1.2 billion in Medicare shared savings. As a result, physician practices working with us have been able to address workforce shortages, develop new programs for patient outreach and care, and identify new solutions to serve their communities. We are committed to working with CMS to grow program innovation and participation that improves patient health care experiences and outcomes while saving taxpayer dollars.”

This article was originally posted August 24, 2023 by Mark Hagland on the Healthcare Innovation Group site:[pull]=omeda|1979F6800212J0P&oly_enc_id=1979F6800212J0P