More MSSP ACOs will participate in risk-based tracks in 2018

Of the 561 accountable care organizations (ACOs) participating this year in the Medicare Shared Savings Program (MSSP), 101, or 18 percent, are in a downside risk-based contract.

Last year, only 42, or 9 percent, of MSSP participants took on downside risk, according to CMS data, and only 5 percent did so in 2016.

Most of this year’s 101 ACOs with a downside risk-based contract are participating in Track 1+, a new risk model CMS introduced this year that doesn’t expose participants to as much financial risk as Tracks 2 or 3. A total of 55 ACOs are participating in Track 1+, 8 are in Track 2 and 38 are in Track 3. The remaining 460 are in Track 1, which has no downside risk.

Slightly more than three-quarters of the 65 ACOs that had the option to renew their MSSP participation this year chose to do so, compared with about 64 percent of ACOs that renewed last year.

In all, 124 of this year’s 561 participating ACOs are new to the program. According to Advisory Board, MACRA was one of the main reasons that organizations decided to join an ACO—either to receive a 5 percent APM bonus or to simplify their reporting under the Merit-based Incentive Payment System.

Our Take: Despite the current administration’s attempt at dismantling Obamacare—and so far, nearly succeeding—the volume-to-value movement hurls forward in 2018.

Last year, under then-HHS Secretary Tom Price, more than a few analysts speculated that the ACO program was on its way out. Instead, in 2018, we’ve seen the largest percentage growth in the Medicare ACO program since 2014. And as providers become more familiar with the model, more of them are taking on risk—which is what the framers of the ACO concept intended.

Payers, too, have embraced the ACO model. At last count we noted more than 2,000 commercial ACO agreements in place, not including bundles and other incentive programs that payers have created to keep people healthy and out of the hospital. From the early days of the Pioneer ACO program, Cigna, UnitedHeatlhcare, Humana and others have been marketing ACOs to employers as a lower cost, better care option.

It’s safe to say that for now, ACOs and bundled payments—hallmark programs of the Affordable Care Act—are here to stay.

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