The Centers for Medicare & Medicaid Services (CMS) is taking a new direction with the Medicare Shared Savings Program, established by the Affordable Care Act. The new ruling, called Pathways to Success, is meant to encourage Medicare’s Accountable Care Organizations (ACOs) to move to performance-based risk faster and incrementally. The new ACO criteria will take effect July 1, 2019.
New Participation Tracks
The ruling restructures participation options, eliminating the one-sided shared savings-only model and the two-sided shared savings and shared losses model. A new BASIC track incrementally transitions eligible ACOs to higher levels of risk and potential reward. A second ENHANCED track provides additional tools and flexibility for ACOs taking on the highest level of risk and potential reward.
Effect on the Health Care Industry
According to CMS, 561 ACOs out of 649 total Medicare ACOs participate in the program. These ACOs served more than 10.5 million Medicare fee-for-service beneficiaries in 2018. The ruling is estimated to save the program approximately $2.9 billion over 10 years.All Insights