In late September 2019, the Centers for Medicare and Medicaid Services (CMS) released the performance results for the sixth year (2018) of Medicare’s flagship Accountable Care Organization (ACO) program, the Medicare Shared Savings Program (MSSP). Over the last several years and from a variety of different angles, we have tracked the progress of this program, which has generally shown good quality of care and outcomes, and modest but increasing cost savings over time, relative to CMS benchmarks.
The program’s 2018 performance builds on previous results. In 2017, the MSSP achieved net savings for Medicare relative to its benchmarks for the first time. In 2018, net savings per capita have more than doubled to $73 compared to $35 last year. Because counterfactual studies suggest that performance against financial benchmarks substantially underestimates true savings, actual savings in 2018 were likely significantly larger and appear to be growing over time. These increased savings occurred in the context of significantly greater adoption of “downside” financial risk, with participation in downside risk doubling from 8 percent last year to 17 percent this year. Further, now all types of ACOs are achieving net savings on average – including physician-led, hospital-led, and integrated ACOs, as well as small, medium, and large ACOs (based on membership).