The Medicare Shared Savings Program (MSSP) is a progressive risk sharing program created as part of the Affordable Care Act in 2010 that enables physician networks to take risk against a budget and share in potential savings. Within the program, physicians create Accountable Care Organizations (ACOs) to cover a Medicare Fee for Service (FFS) population and opt in to one of two participation tracks with varying savings/loss rates. In Performance Year 2022, a total of 483 ACOs covering 11 million beneficiaries earned a total $2.5 billion in shared savings.¹

Applications open annually, and the application deadline to join the MSSP ACO program on January 1, 2025 is fast approaching. Key application deadlines are below:

During Phase 1 of the application window that opens on May 20, 2024, prospective applicant ACOs must select the track or level in which they wish to participate as well as the minimum savings and loss rates and beneficiary assignment methodology.

Physician leadership should take steps now to decide whether they will apply and to prepare for the upcoming application. COPE Health Solutions proposes the following key considerations:

• Assess and align on your organization’s risk readiness and optimal risk track
  • Review how overlaps with other CMS models permitted (AHEAD) and not permitted (ACO Reach, MCP) may be a consideration
• 3 Day SNF Waiver Rule: Calculate ROI prior to electing to apply
  • Align your organization’s understanding of the investment level needed for maximal return and shared savings amounts
• Impacts of expanded use of telehealth rules
• Assess changes to risk adjustment

If you are considering joining an MSSP ACO, CHS can help evaluate your risk profile and estimate potential performance. Our team of experts can support your team in configuring your arrangement to best mitigate risk and maximize reward while subsequently designing a roadmap to optimize your operational and care models. Please do not hesitate to reach out at info@copehealthsolutions.com or 213-259-0245.

Footnote:

¹ https://www.cms.gov/files/document/2024-shared-savings-program-fast-facts.pdf