Final Rule Creates Pathways to Success for the Medicare Shared Savings Program

Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that dramatically redesigns and sets a new direction for the Medicare Accountable Care Organizations or “ACOs.” ACOs are groups of healthcare providers that take responsibility for the total cost and quality of care for their patients, and in exchange they can receive a portion of the savings they achieve. To ensure the ACO program delivers the most value, Pathways to Success is designed to advance five goals: Accountability, Competition, Engagement, Integrity, and Quality. 

The Medicare Shared Savings program (MSSP) launched in 2012 and currently over 10.4 million beneficiaries in Fee-for-Service Medicare (of the 38 million total Fee-for-Service beneficiaries) receive care from providers participating in a Medicare ACO. Most Medicare ACOs currently do not face financial consequences when costs increase, but Pathways to Success will change this. Having more Accountable Care Organizations take on real risk, while offering them the incentives and flexibility they need to coordinate care and innovate, is an important step forward in how Medicare pays for value. Data on ACO performance shows that over time ACOs taking accountability for costs perform better than those that do not. As a result of today’s changes, the projected savings to Medicare total $2.9 billion over ten years.

Invitations for a national partner call will come out soon to walk through this final rule: “Pathways to Success”

For more information

https://www.cms.gov/newsroom/fact-sheets/final-rule-creates-pathways-success-medicare-shared-savings-program