Medicare Shared Savings Program Saves Medicare $1.66 Billion in 2021, Centers for Medicare & Medicaid Services announced Tuesday. This is the fifth year in a row that the program has generated savings.
The Medicare Shared Savings Program works with Accountable Care Organizations (ACOs), which are groups of doctors, hospitals, and other health care providers. These ACOs collaborate to provide high-quality care and avoid unnecessary services in a value-based purchasing model. By doing this and spending health care money wisely, the ACO may be able to share the savings it achieves with the Medicare program. This differs from the fee-for-service model because it pays providers for the quality of care versus the quantity of services provided, which has led to a spike in costs.
“We are encouraged and inspired by five consecutive years of savings and quality improvement,” Meena Seshamani, CMS deputy administrator and director of the Center for Medicare, said in a news release. “The learnings from the Shared Savings Program can and should be applied across the industry, driving the system to higher quality care.”
Nearly all participating ACOs, or 99 percent, met the Savings Sharing Program’s quality requirements, and about 58 percent earned performance payments in 2021, CMS said. Low-income ACOs achieved $237 per capita in net savings, compared to high-income ACOs, which had $124 per capita in net savings.
“The type of ACOs that saw more net savings tended to be low-revenue, meaning they were composed primarily of physicians, included a small hospital, or served rural areas,” CMS said.
Additionally, ACOs comprised of 75% primary care clinicians or more had $281 per capita net savings, compared to $149 per capita 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,” CMS said.
ACOs in the program had better performance rates than groups outside the program, including better quality measures for diabetes and blood pressure control, breast and colorectal cancer, falls risk screening rates and flu vaccination, it said CMS. However, the organization was unable to provide supporting data at the time of publication.
The program also benefits behavioral health, as ACOs have better depression screening and depression remission rates than those not in the program.
Aledade — who works with independent practices, health centers and clinics to build ACOs — said in statement that its ACOs have saved Medicare more than $390 million. Additionally, four of the 10 top-performing ACOs in the program were with Aledade, said CEO Dr. Farzad Mostashari.
“Today’s news is a reminder that CMS’ goal of having every Medicare beneficiary have an accountable care relationship by 2030 is the right thing to do,” Mostashari said. “We need to get more doctors and patients on board with these payment models as quickly as possible. The results prove that this will mean better care and lower costs in the health care system. We are honored to be part of such important work with dedicated healthcare professionals across the country.”
CMS is working to improve the Shared Savings Program by announcing proposed changes earlier this year, which will encourage more participation, especially among providers in rural and underserved communities. This includes giving advance payments to certain new ACOs in these areas to meet social needs.
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