CMS: 3 initiatives to get 100% of original Medicare beneficiaries in ACOs by 2030

CMS has launched three initiatives to grow and provide higher quality care to more than 13.2 million Medicare beneficiaries in 2023, helping the agency hit its goal of enrolling all people with traditional Medicare in an accountable care relationship with their provider by 2030.

Seven things to know:

1. More than 700,000 providers and organizations will participate in at least one of the three initiatives — the Medicare Shared Savings Program, the ACO Realizing Equity, Access and Community Health Model, and the Kidney Care Choices Model.

2. ACOs are groups of physicians, hospitals and other providers, who collaborate to provide coordinated, high-quality care to Medicare patients. The benefits of ACOs include reduced costs and higher quality care, which ties into a healthcare organization's bottom line as well as the patient's overall health. It also improves experiences system-wide, since both physicians and patients are motivated to resolve medical issues quickly and efficiently.

3. Last year, CMS outlined its vision for increasing access to accountable care by supporting organizations new to value-based care and shared savings to increase participation in ACOs, improving health equity by expanding the reach of ACOs in underserved communities and scaling successful features of model tests into the Medicare Shared Savings Program.

4. The agency also aims to improve transparency for specialist data and quality measures, ramp up bundled payment models, advance primary and specialty care coordination, and create financial incentives for ACOs to manage specialty care. 

5. The Medicare Shared Savings Program is the largest ACO in the U.S. As of 2023, the program has 456 ACOs and 10.9 million assigned beneficiaries — a slight decrease from the prior year. However, CMS expects the 2023 Physician Fee Schedule to grow program participation in 2024 and beyond, when many new policies take effect. The policies are designed to increase participation, particularly in rural and underserved areas, promote equity, strengthen alignment across ACOs and increase the number of beneficiaries assigned to ACOs in the program by up to 4 million in the coming years.

6. The ACO Reach Model aims to boost the quality of care for traditional Medicare beneficiaries through improved care coordination and increased access to accountable care in underserved areas. The model will test benchmark adjustments to shift payments to better support care for the underserved and enhanced Medicare benefits, including at-home care. For 2023, the model has 132 ACOs with 131,772 providers and organizations providing care to about 2.1 million beneficiaries. This year, ACO Reach will have 824 federally qualified health centers, rural health centers and critical access hospitals participating — more than double the number from 2022, according to CMS. Over 55 percent of Reach ACOs have self-reported as provider organizations.

7. The Kidney Care Choices Model focuses on coordinating care for Medicare beneficiaries with chronic kidney disease stages 4 and 5 and end-stage renal disease. It also focuses on areas of concern for this population, including delaying the onset of dialysis and increasing access to kidney transplantation so more patients can live fuller and longer lives, CMS said. For 2023, the model will include 130 entities accountable for the quality and care for their aligned beneficiaries. This year, the model will have more than 8,398 participating providers and organizations and 249,893 beneficiaries — an increase of 87 percent and 62 percent increase over 2022, respectively. The second cohort of the model expands into new areas, such as North Dakota and South Dakota. 

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