As health systems seek growth opportunities in the employer market, participating in accountable care organizations (ACO), which originally sprang up within Medicare, is a potentially valuable approach.

The Centers for Medicare and Medicaid Services (CMS) delivered sweeping changes on December 21, 2018. They should come as no surprise given the clear indications of the new direction throughout 2018.

CMS issued a final rule Dec. 21 that makes sweeping changes to the Medicare Shared Savings Program, including overhauling the way ACOs share in risks and rewards.

Blue Cross and Blue Shield of North Carolina and Aledade — a Bethesda, Md.-based ACO startup — joined forces to help hundreds of physicians in North Carolina launch ACOs.

An updated independent estimate suggests Medicare Shared Savings Program ACOs saved more than $1 billion more than CMS says they did.

Fort Myers, Fla.-based Millennium ACO netted $29.7 million during the 2017 Medicare Shared Savings Program year, making it the best-performing ACO in terms of shared savings that year.

Greensboro, N.C.-based Cone Health and its subsidiary Triad HealthCare Network, also in Greensboro, entered Aetna's ACO effective immediately.

Nine representatives from the House penned a letter to CMS Administrator Seema Verma urging the agency to soften a proposed rule that would rapidly increase the timeline for Medicare Shared Savings Program ACOs to take on downside financial risk.

In any other industry, companies work hard to interpret purchasing and regulatory trends and adapt quickly in times of change.

America's Physician Groups — a professional association for medical groups that operate under a capitated, coordinated care model — launched a learning collaborative Oct. 22 that aims to support providers taking on risk and to help develop the next Advanced Alternative Payment Models.

The National Association of ACOs found more than a third of ACOs said they are likely to leave the Medicare Shared Savings Program if a proposed rule takes effect.

Southwestern Health Resources, the clinically integrated network formed by Arlington-based Texas Health Resources and UT Southwestern Medical Center in Dallas, collaborated with Blue Cross and Blue Shield of Texas to create an ACO, the organizations said Oct. 16.

The American Medical Group Association and the American Hospital Association issued responses to CMS' proposed changes to the Medicare Shared Savings Program and made various recommendations to the agency.

An independent analysis found Medicare Shared Savings Program ACOs generated $1.84 billion in gross savings from 2013 to 2015 — nearly twice as much as the CMS estimate of $954 million.

Physician-led ACOs saved Medicare $256.4 million in 2015, but hospital-led ACOs actually cost the program money that same year, according to a study published in The New England Journal of Medicine.

ACOs continued to grow in size and count in 2017 and early 2018, according to an analysis from Leavitt Partners and the Accountable Care Learning Collaborative. 

ACOs participating in the Medicare Shared Savings Program generated $314 million in net savings to Medicare in 2017, when incorporating bonuses paid to the ACOs, according to MSSP performance data released by CMS Aug. 30.

Although Next Generation ACOs have performed well in their first year, health IT challenges like interoperability may be standing in their way of achieving greater success, according to a CMS evaluation prepared by NORC at the University of Chicago.

Next Generation ACOs saved Medicare about $62 million during their first performance year in 2016, CMS said Aug. 27.

CMS told Medicare contractors Aug. 10 that certain care management home visits under the Next Generation ACO model will be reimbursed by Medicare beginning in January.