CMS Announces Increased Participation in ACO Initiatives to Improve Care for Medicare Patients

The Centers for Medicare & Medicaid Services (CMS) announced increased participation this year in their accountable care organization (ACO) initiatives in a press release on January 29, 2024. This development is expected to enhance the quality of care for patients with Medicare.  

In 2024, 19 newly formed accountable care organizations (ACOs) in the Medicare Shared Savings Program (Shared Savings Program) will receive over $20 million in advance investment payments (AIPs) to care for underserved populations due to a new, permanent payment option. Additionally, 50 new ACOs have joined the program alongside 71 existing, renewed ACOs, totaling 480 ACOs now in the Shared Savings Program. This program is the largest ACO program in the United States. Furthermore, 245 organizations will continue participating in the ACO Realizing Equity, Access, and Community Health (ACO REACH) and Kidney Care Choices (KCC) models offered by the CMS Innovation Center. 

“The strong participation in our accountable care models in 2024 will help more people access high-quality, coordinated health care that will improve their quality of life,” said CMS Deputy Administrator and Innovation Center Director Liz Fowler. “The ACO REACH and KCC models are a cornerstone of our strategy to transform the health care system, focus on equity in everything we do, and deliver person-centered care that meets people where they are.”    

ACOs (hospitals and health care professionals) receiving AIPs must invest in health care infrastructure, staff, and provide accountable care for underserved beneficiaries.  

“These 19 new ACOs are hiring community health workers, utilizing health assessment and screening tools, and implementing quality improvement activities, such as case management systems, patient registries, and electronic quality reporting,” said CMS.  

In 2024, the growth of 3 innovative ACO initiatives—the Shared Savings Program, the ACO REACH Model, and the Kidney Care Choices model—aims to provide higher-quality care for people with Traditional Medicare. This is done by ensuring permanent ACO coverage, enhancing care for underserved and rural populations, and coordinating care for individuals with chronic kidney disease and end-stage renal disease.  

This year, a 3% increase of people with Traditional Medicare is aligned to an ACO (about 13.7 million). ACOs serve almost half of the Traditional Medicare population due to their superior quality performance and ability to generate yearly savings for the Medicare Trust Fund compared to non-participating physician groups. 

The 2023 Physician Fee Schedule final rule issued by CMS takes steps to align value-based programs, promote accountable care, and establish a fairer health care system. CMS has incorporated components from an Innovation Center model test that demonstrated cost savings and maintained quality in the Medicare program. Following the success of the ACO Investment Model in increasing ACO participation in underserved areas and saving Medicare Trust Funds, CMS has integrated key elements into the Shared Savings Program as AIPs. Like the model test, CMS has observed increased participation among health care providers from rural and underserved areas in the first year of implementation. These actions build upon previous ACO model tests, such as the Pioneer ACO Model and the Medicare ACO Track 1+ Model, which have informed the development of higher-risk tracks in the Shared Savings Program. 

In 2024, the Shared Savings Program will consist of 480 ACOs, involving 634,657 health care providers and serving over 10.8 million individuals with Traditional Medicare. With the inclusion of ACOs receiving AIPs, care delivery to people with Traditional Medicare will occur in 9,032 Federally Qualified Health Centers, Rural Health Clinics, and critical access hospitals, marking a 27% increase from 2023.  

Additionally, the ACO REACH Model for 2024 will comprise 122 ACOs, with 173,004 health care providers caring for an estimated 2.6 million people with Traditional Medicare. The participation of 1,042 Federally Qualified Health Centers, Rural Health Clinics, and Critical Access Hospitals signals a more than 25% increase from 2023. Expanding the number and presence of ACOs in underserved communities aims to address racial and ethnic disparities identified among individuals with Traditional Medicare in accountable care relationships.   

Furthermore, the KCC model for 2024 includes 123 Kidney Contracting Entities (KCEs) and CMS Kidney Care First (KCF) Practices, responsible for ensuring the quality of care for Medicare beneficiaries with chronic kidney disease and end-stage renal disease. The KCC Model will feature over 9,227 participating health care providers and organizations, a 10% increase from the previous year, servicing 282,335 individuals with Medicare. 

“The new advance investment payments will enable health care providers in rural and other underserved areas to build the staffing, infrastructure, and care delivery improvements they need to succeed as ACOs providing high quality, equitable, accountable care to their communities,” said Meena Seshamani, MD, PhD, deputy administrator and director of the Center for Medicare. “Everyone deserves access to the type of whole-person care delivered by ACOs.” 

Reference 

Centers for Medicare & Medicaid Services. Participation continues to grow in CMS’ Accountable Care Organization initiatives in 2024. News release. CMS. Published January 29, 2024. Accessed February 1, 2024. https://www.cms.gov/newsroom/press-releases/participation-continues-grow-cms-accountable-care-organization-initiatives-2024