A critical opportunity for Accountable Care Organizations (ACOs)  The Medicare Shared Savings Program (MSSP) is a critical opportunity for Accountable Care Organizations (ACOs) aiming to improve care coordination while reducing healthcare costs. For organizations looking to join or renew their participation in MSSP for a Jan. 1, 2026, start date, the Centers for Medicare and Medicaid Services (CMS) has released key application deadlines that ACOs must follow.  Key application dates  Application period opens: May 29  Final submission deadline: June 12, at noon (ET)  All applications must be submitted through the ACO Management System . To ensure a smooth application process, ACOs should review the Medicare Shared Savings Program Overview and plan accordingly.  How DataGen supports ACOs  Successfully participating in MSSP requires robust data analysis  and financial benchmarking. DataGen provides tailored solutions to help ACOs navigate the complex...

The end of the CJR model: A look back at its evolution  In October 2024, the final episodes of the Comprehensive Care for Joint Replacement (CJR) model were initiated, with all episodes ending by Dec. 31, 2024. This was the final performance year of CJR, which spanned eight years overall.   CJR began Apr. 1, 2016. It was CMS’ first mandatory bundled payment model. Hospitals were held financially accountable for lower extremity joint replacement (LEJR) episodes of care and were incentivized to improve care coordination for patients across the continuum.    Key insights from CJR: Successes, adjustments and challenges  CJR had numerous ups and downs over the years, as its scope was adjusted over several administrations through the rule-making process. Here are the five main highlights.  1. CJR’s mandatory participation: A changing landscape  When the CJR model was introduced, participation was mandatory for hospitals in 67 metropolitan statistical a...

On Nov. 25, the Centers for Medicare and Medicaid Services (CMS) released Performance Year (PY) 2022 evaluation findings for the Kidney Care Choices (KCC) voluntary model. The evaluation of the first performance year revealed mixed outcomes.  Kidney Care Choices model evaluation findings for PY 2022  Participation: 30% of Medicare fee-for-service beneficiaries with chronic kidney disease or end-stage renal disease eligible for the model are aligned with a KCC participating entity.    Encouraging trends: CMS reported , “The KCF model option increased the proportion of patients with ESRD dialyzing at home (20%). Home dialysis training increased in CKCC (32%). Both model options increased peritoneal dialysis, the primary modality for home dialysis (KCF: 26% and CKCC: 8%).”  Stable measures: Most quality measures showed no significant changes.  Financial outcomes: There was no measurable impact on overall Medicare costs, savings or losses.  The road a...

Want to supercharge your health and total cost of care strategy? Medicare Accountable Care Organizations can now access CMS shadow bundle data.   This is a unique opportunity for ACOs and clinically integrated networks to reap benefits without assuming any additional financial risk. These benefits include:  improving care delivery;  managing episodes of care within their population; and  promoting engagement with specialists as partners.  If you're ready to do more with your data, continue reading for a complete shadow bundle data overview. We'll examine the four main benefits and discuss how they can help supercharge your analyses. 4 Main shadow bundle benefits  Before we dig in, here’s a brief outline of shadow bundles. Also, use our shadow bundles opportunity analysis info sheet for a quick overview.  What? Shadow bundles capture episodes of care within a defined patient population. CMS’ shadow bundle data for ACOs mirrors the specifications o...

  Authorized by the Affordable Care Act and established in 2012, the Medicare Shared Savings Program is one of CMS’ first accountable care organization models. For the first time in MSSP’s history, the agency will offer payments upfront to encourage more providers to participate. The new Advance Investment Payments option for MSSP participants will begin with performance year 2024. Who is eligible for Advance Investment Payments and what do they receive? Per the CMS AIP guidance , Advance Investment Payments delivers a one-time $250,000 payment upfront to eligible providers who might not otherwise participate in value-based care. These models require substantial infrastructure investments (e.g., technology, staffing, data and analytics partners). CMS will also offer additional quarterly payments per beneficiary per quarter for the first two performance years if the ACO has met MSSP eligibility and compliance requirements. AIP is only available for ACOs who: have never participated ...

Everybody knows: Conferences aren’t just about what you learn but who you meet. Anyone attending the annual National Association of ACOs conference this week in Baltimore should take full advantage of the experts in attendance. This will include executives from leading accountable care organizations, private payers and CMS. NAACOS 2023 will zero in on what you need to know now and who best to learn it from. That includes the industry partners who have helped build incentive-generating infrastructure for the past decade’s most successful ACOs. Analytics first, last and everywhere If there’s any question as to what ACOs need to succeed with alternative payment models, simply look at the topic of NAACOS’ opening session: advanced analytics. There isn’t a single aspect of value-based care that doesn’t happen without analytics: better prevention and primary care; enhanced care coordination; managing risk; benchmarking; and a stronger bottom line. NAACOS sessions will detail these topics wi...

The good news: The Medicare Shared Savings Program (MSSP) has reported a fifth consecutive year of savings while delivering high-quality care for Medicare beneficiaries in accountable care organizations (ACOs). The tricky news: With participation dropping since performance year 2018, ACOs will need places to pivot as success becomes more dependent on risk progression, benchmarking and equity goals. The 2021 MSSP results CMS reported the following highlights from the 2021 MSSP performance year : 99% of participants met the quality targets required for shared savings; 58% earned shared savings; ACOs outperformed non-MSSP providers in metrics related to diabetes, blood pressure, select cancers, fall risk, flu vaccination, tobacco screening and smoking cessation, and screening/remission for depression. ACOs with specific characteristics saved more than their counterparts. This includes ACOs labeled low revenue and those dominated by primary care providers. For example, low-revenue ACOs sa...

Innovation that benefits only the privileged is not progress. While accountable care organizations helped show that a focus on value was missing from healthcare, new ACO priorities reflect that equity has been missing, too — for providers as well as patients. In its recent Strategy Refresh , the Center for Medicare and Medicaid Innovation noted that its “Medicare-focused models have limited reach to Medicaid beneficiaries and safety net providers.” CMMI’s new ACO model and planned improvements to existing ones are designed to help more providers reap the benefits of value-based care. If it’s broke, fix it The objectives of accountable care are clear: higher quality at lower costs, involving less waste and a better experience for all. Those outcomes have not fully arrived. CMMI reports that “only six out of more than 50 models launched have generated statistically significant savings to Medicare and to taxpayers” since 2011. The reasons are many but include the need for a new standa...

Can ACO REACH help CMS and providers achieve the unmet goals of prior alternative payment models? If so, a stronger focus on equity, provider leadership, accountability through risk and evaluation may make the difference. Announced Feb. 24, ACO REACH — Accountable Care Organization Realizing Equity, Access, and Community Health — is CMS' newest voluntary APM. Robust resources and capabilities will be needed to navigate its requirements. As highlighted in a recent CMS webinar , ACO REACH is the first APM to launch following a Strategy Refresh by the Center for Medicare and Medicaid Innovation. ACO REACH aligns with the CMMI objective of driving accountable care to improve cost and quality and will replace the current Global and Professional Direct Contacting program, effective Jan. 1, 2023. CMMI encourages current GPDC participants and new entrants to apply, noting that selection criteria and performance monitoring will be more stringent. This blog highlights key differences bet...