Spread of ACOs And Value-Based Payment Models In 2019: Gauging the Impact of Pathways to Success

In December 2018, the Centers for Medicare and Medicaid Services (CMS) announced a major overhaul of the Medicare Shared Savings Program (MSSP) by finalizing Pathways to Success. This was one of the largest changes to the Medicare ACO program since its initiation, with the most visible change being the shorter timeframe for ACOs to transition to downside risk (and to higher levels of downside risk). Some ACOs left the program after the overhaul was finalized, but it was unclear how many ACOs would enter the program, due to a staggered timeline for exits and entrances this year during the transition.

This blog summarizes the recently released enrollment data for Medicare ACOs and updates some of our previous work on tracking all ACOs (commercial and Medicaid ACOs included) and participation or potential participation in other value-based payment models. The latter information is pulled from Torch Insight (a health care database from Leavitt Partners Insight). This work builds off of a recent examination of MSSP public data by authors from the National Association of ACOs, adding information on ACOs across all payers, geographic patterns, trends in risk-bearing by ACO leadership structure and size, and trends in other Department of Health and Human Services efforts to expand value-based payment arrangements beyond ACOs.