Get MEDICARE SHARED SAVINGS PROGRAM. MEDICARE SHARED SAVINGS PROGRAM

ACOs must have at least 5,000 Medicare fee-for-service (FFS) beneficiaries assigned to their ACO in each benchmark year to be eligible for participation in the Shared Savings Program. For Shared Savings Program ACO locations and contact information, refer to Program Data.

The focus of an ACO is on improving care quality and reducing costs through care coordination and preventive measures. On the other hand, an MCO (Managed Care Organization) is a healthcare organization that contracts with insurance companies to provide healthcare services to their members.

The MSSP ACO model continues to pay providers through the Medicare fee for service (FFS) model. ACO REACH has a required fee reduction for participant providers (not for preferred providers) and the payment is sent from the ACO after the claims are processed by CMS.

The Medicare Shared Savings Program (Shared Savings Program) promotes accountability for a patient population, improves the coordination of items and services for Medicare fee-for-service (FFS) beneficiaries, and encourages investment in high-quality and efficient services.

Whereas MSSP uses the tried-and-true FFS payment model, ACO REACH provides more advanced alternative payment arrangements, such as capitation and preferred provider arrangements, and includes additional benefit enhancement. MSSPs also have more flexibility in how they structure their programs and how they provide care.

The shared savings rate is the percentage of any estimated savings (compared with benchmark) that is paid to the ACO, subject to meeting any requirements for quality performance. For example, an ACO with a savings rate of 50 percent that outperforms its benchmark by 3 percent would keep 1.5 percent of benchmark spend.

The MSSP is a permanent ACO program in traditional Medicare that provides financial incentives for meeting or exceeding savings targets and quality goals. The MSSP program has multiple tracks that allow ACOs to choose between sharing in both savings and losses, or just savings.

While ACO activity is prevalent across health care payer types, most ACO activity occurs under the Medicare program through models instituted by the Centers for Medicare & Medicaid Services (CMS) and CMS Innovation Center.