37% of ACOs are taking on downside risk

More accountable care organizations are taking on downside financial risk in the Medicare Shared Savings Program than ever before, with 37% in the program today participating in these arrangements.

This is a notable increase in the number of downside-risk ACOs, according to an analysis from Avalere Health. By comparison, just 10% of ACOs assumed downside risk annually from 2012 to 2017.

The increase is due to an overhaul of the MSSP, after CMS required ACOs to assume downside financial risk in their arrangements after just two years of participation, as opposed to six years previously. The vast majority of ACOs under the old rules participated as only taking upside risk, meaning they would share in financial savings but not have to pay back any financial losses to Medicare. However, the rule changes also led fewer ACOs to participate in 2020 and 2019.

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