A Look at the 2019 Medicare Shared Savings Program: Results, Findings & Changes to Come

The Centers for Medicare and Medicaid Services (CMS) released the 2019 Medicare Shared Savings Program (MSSP) results which ranks the savings and quality performance of participating Accountable Care Organizations (ACOs). According to CMS data, the 541 MSSP ACOs generated $1.19B in savings to Medicare and $856M in earned shared savings. Additionally, 92% of ACOs achieved quality of care rewards.  

The Shared Savings Program has undergone significant changes over the last year, introducing a new “Pathways to Success” redesign which officially began in July 2019. One of the most impactful changes under Pathways to Success is the accelerated glide path to financial risk for ACOs, which generally requires them to take on financial risk after two years, compared to up to 6 years under the prior program parameters. Because of the program redesign, a new cohort of MSSP ACOs began in July 2019 under the updated “Pathways to Success” program rules and many more ACOs, 29%, took on two-sided risk. As of July 2019, MSSP ACOs covered just under 11 million Medicare fee-for-service beneficiaries.

Before discussing results, it’s helpful to define how CMS refers to savings within the MSSP.  CMS defines generated savings as the total savings achieved by ACOs overall that impact overall Medicare spending. Earned shared savings, on the other hand, are the hard dollars an organization receives back from Medicare in shared savings based on two variables: the amount of risk they take on and their performance both relative to the benchmark savings rate set by Medicare and their performance on quality measures.

Program Changes in 2020 & Beyond

Due to COVID-19, CMS has implemented policies to address and mitigate concerns from ACOs. Specifically, CMS has canceled the 2020 application cycle with the intent to resume adding new MSSP ACOs for the 2022 performance year. In addition, CMS has provided flexibility on quality reporting requirements and has removed COVID-19 associated costs for treatment episodes that include an inpatient admission for calculating financial benchmarks and performance year spending. ACOs are also able to use telehealth visits for beneficiary assignment and are able to extend their participation agreement in the Shared Savings Program for an additional year under their current risk track. 

In addition to programmatic changes to the MSSP caused by COVID-19, CMS is also moving forward with new value-based care models including Direct Contracting, the Community Health Access and Rural Transformation (CHART) Model, and Primary Care First that focus on improving quality, access, and coordination of care as well as reducing costs. PatientPing is poised to support and partner with participants in these new models over the next year and beyond. 

Celebrating the Impact

In 2019, PatientPing partnered with 70 MSSP ACOs across the country of which 69 ACOs (99%) generated savings for Medicare totaling over $517M and 45 ACOs (65%) earned shared savings totaling over $261M. Furthermore, 85% of ACOs in two-sided risk that partnered with PatientPing earned shared savings – averaging over $5 million earned shared savings each. In comparison, ACOs in two-sided risk tracks that did not partner with PatientPing received on average only about half  in earned shared savings,  $2.8M each. Of note, PatientPing’s ACO customers represent 50% of the top 15 ACOs that earned savings. In addition, PatientPing’s ACO customers’ average quality score was an impressive 95% outperforming most other ACOs and achieving 2% improvement compared to 2018 customer results.

PatientPing congratulates its Medicare Shared Savings Program ACO customers for these results and recognizes their commitment to providing better-coordinated care.

Learn More About PatientPing

With the PatientPing platform, ACOs, other providers such as hospitals, post-acute, and community providers, as well as payers are able to collaborate on patient care throughout the entire healthcare continuum– increasing engagement among acute, post-acute, and ambulatory providers as well as across entire provider networks.

To learn more about the MSSP program, or how PatientPing helps organizations succeed, contact [email protected]