On September 14, the Centers for Medicare and Medicaid Services (CMS) released performance results for the seventh performance year (2019) of the Medicare Shared Savings Program (MSSP). Overall, 541 different accountable care organizations (ACOs) participated, and, consistent with our findings in prior years, ACOs continued to show year-over-year improved financial performance, generating $1.2 billion in net savings in performance year 2019 relative to CMS’s benchmarks. Actual savings may even be larger since comparing an ACO against its program benchmarks may substantially underestimate true savings.
Notably, 2019 was the first year CMS enacted “Pathways to Success,” the most significant redesign of the program to date. Pathways to Success policies accelerate the time frame for ACOs to transition to “downside risk” and revised methodologies for calculating benchmarks, shared losses, quality scores, and other key program performance specifications. The program, which went into effect on July 1, 2019, also introduced certain flexibilities for ACOs defined as “low revenue” to help support smaller, more rural, more physician-led, or otherwise more resource-constrained ACOs. As a result, more ACOs of all types were in downside risk after Pathways to Success than in any prior year.