Health Care Matters | November 01, 2024
MSSP ACOs Save Medicare $2.1B in 2023, The Largest Savings in Program History
For the seventh consecutive year, CME announced the Medicare Shared Savings Program (MSSP) generated savings. In 2023, MSSP ACOs saved Medicare $2.1 billion and earned $3.1 billion in shared savings, generating the largest savings to Medicare in program history. Once again, ACOs led by primary care clinicians had significantly higher net savings than those with a lower proportion of primary care clinicians, underscoring the importance of primary care to the success of the MSSP. ACOs also demonstrated significant improvements in quality measures related to diabetes and blood pressure control, breast cancer and colorectal cancer screening, screening for future fall risk, statin therapy for prevention and treatment of cardiovascular disease, and depression screening and follow-up.
Why It Matters
The MSSP is central to CMS achieving its aims to have all traditional Medicare beneficiaries in an accountable relationship by 2030. Participation in the MSSP is growing, up 5.3% between January 2023 and January 2024 and CMS continues to innovate within the program to bring in new entrants, including the upcoming Center for Medicare and Medicaid Innovation model ACO Primary Care Flex which provides upfront and per member per month payments to participating primary care providers in MSSP. In the 2025 proposed Medicare Physician Fee Schedule, CMS also proposed a prepaid shared savings option to invest in services for beneficiaries, such as meals and transportation. These new programs and policies are aligned with CMS’s broader goals of enhancing primary care and expanding access to underserved communities to ensure equitable access to high-quality care for all Medicare beneficiaries. The continued success of the MSSP in both generating savings and improving quality demonstrates the value of coordinated, whole-person care and reinforces that ACOs are a critical mechanism to transform health care delivery.
The ACA Did Not Increase Spending Growth, So We Can Expand Coverage Further
When the Affordable Care Act (ACA) was passed in 2010, there were two major concerns raised by its opposers: coverage would be too expensive and therefore would not lead to more people having health insurance and it would increase health care spending. Fourteen years later, we can categorically say neither of those concerns have come to fruition. The number of uninsured Americans fell by 25 million and the ACA did not accelerate cost growth.
Read more here.
Why It Matters
The findings suggest, as the article title states, that it is feasible to expand health care coverage without significantly increasing costs by using a myriad of cost control mechanisms. For example, ACA reforms such as Medicaid expansion and marketplace subsidies have successfully improved access to care while holding costs steady. There is still work to do to further the impact of these reforms. Ten states still have not expanded Medicaid which would allow for increased coverage at lower payment rates than the commercial market. Some cost control mechanisms have also been overstated, such as the use of high deductible health plans which have been shown to have limited impact on cost growth but make health care increasingly ineffective even though coverage has expanded. To combat this, efforts should be made to make the commercial marketplace more attractive to those that need it most by increasing the actuarial value of plans through mechanisms like lowering deductibles.
Where We Are going
Financial Integration of Medicare and Medicaid: Necessary But Not Sufficient
Join Health Affairs on November 7th for a virtual event highlighting how states have promoted Medicare and Medicaid integration and how federal policy can better care for people who are dually eligible.
New VBC Resources
The Health Care Transformation Task Force released a resource highlighting case studies and strategies implemented by Task Force provider members to advance health equity through value-based care.
