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PRESS RELEASE

MEDICARE SHARED SAVINGS PROGRAM SAVES MEDICARE MORE THAN $1.6 BILLION IN 2021
AND CONTINUES TO DELIVER HIGH-QUALITY CARE



Aug 30, 2022
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The Centers for Medicare & Medicaid Services (CMS) announced today that the
Medicare Shared Savings Program, through its work with Accountable Care
Organizations (ACOs) – groups of doctors, hospitals and other health care
providers -- saved Medicare money while continuing to deliver high-quality care.
Specifically, the program saved Medicare $1.66 billion in 2021 compared to
spending targets. This marks the fifth consecutive year the program has
generated overall savings and high-quality performance results.  

“This program has delivered more than $1.6 billion in savings and delivered
high-quality health care to millions of people,” said HHS Secretary Xavier
Becerra. “Just last month, we proposed ways to further grow and expand this
successful program, especially in rural and underserved communities. The
Biden-Harris Administration will continue to do everything we can to strengthen
Medicare and ensure everyone can access high-quality, affordable health care.”  

“The Medicare Shared Savings Program demonstrates how a coordinated care
approach can improve quality and outcomes for people with Medicare while also
reducing costs for the entire health system,” said CMS Administrator Chiquita
Brooks-LaSure. “Accountable Care Organizations are a true Affordable Care Act
success story, and it is inspiring to see the results year after year. The
Biden-Harris Administration and CMS are committed to a health care system that
delivers high-quality affordable, equitable, person-centered care – and a
Medicare program that can deliver just that.” 

Shared Savings Program ACOs are groups of doctors, hospitals, and other health
care providers who collaborate to give coordinated high-quality care to people
with Medicare, focusing on delivering the right care at the right time, while
avoiding unnecessary services and medical errors. When an ACO succeeds in both
delivering high-quality care and spending health care dollars more wisely, the
ACO may be eligible to share in the savings it achieves for the Medicare program
(also known as performance payments). 

Over the past decade, the Shared Savings Program has grown to one of the largest
value-based purchasing programs in the country. Value-based purchasing programs
focus on the quality of care provided to people on Medicare, not just the
quantity of services. As of January 2022, Shared Savings Programs include over
525,000 participating clinicians who provide care to more than 11 million people
with Medicare. Based on the program’s success and opportunities to continually
improve value for people with Medicare and the health care system, CMS has set a
goal that 100 percent of people with Traditional Medicare will be part of an
accountable care relationship by 2030.   

“We are encouraged and inspired by five consecutive years of savings and quality
improvement,” said Meena Seshamani, MD, PhD, CMS Deputy Administrator and
Director of the Center for Medicare. “Learnings from the Shared Savings Program
can and should be applied across the industry, driving higher quality care
system-wide. CMS looks forward to continually improving the program, expanding
the reach of participating ACOs and addressing critical health disparities
across the country.”

Earlier this year, in the Calendar Year (CY) 2023 Physician Fee Schedule
proposed rule, CMS proposed changes to the Medicare Shared Savings Program that
would promote participation among health care providers, especially in rural and
underserved areas, helping to grow this successful program to improve access to
ACOs for more people with Medicare. In particular, CMS is proposing to
incorporate advance payments to certain new ACOs in rural and underserved
communities that could be used to address social needs, one of the first times
Traditional Medicare payments would be permitted for such uses. CMS is also
proposing that smaller ACOs have more time to transition to downside risk, and a
health equity adjustment to an ACO’s quality performance score that would reward
excellent care delivered to underserved communities. In addition, CMS is
proposing benchmark adjustments to encourage more ACOs to join the program and
to maintain participation amongst current ACOs. If finalized, these improvements
and others would strengthen and grow the successful program, representing some
of the most significant reforms since the program was established in 2011.
Public comments on the CY 2023 Physician Fee Schedule are due by September 6,
2022.  

Nearly all ACOs – 99% – reported and met the quality standard required to share
in savings under the Shared Savings Program. ACOs had higher mean performance on
quality measures compared to other clinician groups not in the program. This
includes higher performance for quality measures related to diabetes and blood
pressure control; breast cancer and colorectal cancer, and falls risk screening
rates; flu vaccination; tobacco screening and smoking cessation; statin therapy
for the treatment and prevention of cardiovascular disease. ACOs also had better
performance on depression screening and depression remission rates, underscoring
how this type of coordinated, whole-person care can improve treatment of
behavioral health conditions in ACOs, in helping to achieve the goal of
strengthening behavioral health quality in CMS’ Behavioral Health Strategy. 

Approximately 58% of participating ACOs earned payments for their performance in
2021. The type of ACOs that saw more net savings tended to be low-revenue,
meaning they were mainly made up of physicians, included a small hospital, or
served rural areas. With $237 per capita in net savings, low-revenue ACOs lead
high-revenue ACOs, who had $124 per capita net savings. Those ACOs comprised of
75% primary care clinicians or more, saw $281 per capita in net savings compared
to $149 per capita in net savings for ACOs with fewer primary care clinicians.
These results underscore how important primary care is to the success of the
Shared Savings Program and demonstrate how the program supports primary care
providers. 

In addition, CMS is working to advance health equity by designing, implementing,
and operationalizing policies and programs that support health for all people
served by our programs. A health equity analysis of people eligible for
assignment to ACOs in the 2021 performance year demonstrated that lower income
individuals or members of racial or ethnic communities appeared to represent a
disproportionately smaller share of the Medicare population assigned to ACOs. In
line with the Biden-Harris administration’s commitment to advancing racial
equity and support for underserved communities, CMS proposed updates in the CY
2023 Physician Fee Schedule proposed rule, which are designed to improve access
to ACOs in underserved communities. 

For more information on the Medicare Shared Savings Program,
visit https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram  

For more information on the proposals for the Medicare Shared Savings Program in
the 2023 Physician Fee Schedule proposed rule,
visit https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-proposed-rule-medicare-shared-savings-program 

View the 2021 Medicare Shared Savings Program Financial and Quality performance
results at
https://data.cms.gov/medicare-shared-savings-program/performance-year-financial-and-quality-results/data

###

Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS
on Twitter @CMSgov

 

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