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Like a Classic Movie Plot Twist: The Latest News on Medicare ACOs

December 23, 2014
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Yesterday’s announcement from CMS on the addition of 89 new ACOs to the Medicare Shared Savings Program for ACOs feels rather cinematic—and is worth noting

It’s a classic plot device in movies: just when things look darkest, the cavalry rides in, or oil gushes out of the land and the farm is saved, or the couple who fell in love but then were separated by obstacles, become reunited, just in time for the credits to roll. That’s how yesterday’s announcement from the Centers for Medicare & Medicaid Services (CMS) feels, anyway.

That’s because yesterday (Dec. 22), Sean Cavanaugh, deputy administrator and director at the Center for Medicare, CMS, announced via The CMS Blog that a large number of new accountable care organizations (ACOs) are organizing to become part of the Medicare Shared Savings Program (MSSP) for ACOs in 2015. In fact, 89 new ACOs will be joining the program, bringing the total number of MSSP ACOs to 405. And, as Cavanaugh noted, combining the 19 current Pioneer ACOs with the MSSP ACOs brings the total number of ACOs working with Medicare to 424 collaboratives serving over 7.8 million Medicare beneficiaries.

Yes, but that 424 figure disguises some of the troubles in the Pioneer ACO program in the past couple of years, with that number dropping from 32 in January 2012 to 19 as of this autumn. The reality is that Medicare ACO development and participation are turning out to be more difficult and challenging than anyone expected. Indeed, the Pioneer program in particular is in serious difficulty right now, despite some serious gains being made by some of its participant ACOs.

Still, this news that 89 new ACOs are joining the MSSP program is unqualified good news for CMS, and couldn’t have come at a better time for the agency. The simple reality is that the learnings taking place in both the MSSP and Pioneer programs are going to be essential to broad progress in U.S. healthcare going forward, as health risk assessment, population health management, care and case management, and data analytics principles and strategies are developed and implemented.

And those in the industry so ready to throw darts at Medicare should take a pause here, because when it comes down to it, we’re all in this together, and whatever can promote and enhance the success of the two Medicare ACO programs will ultimately benefit everyone—and most especially patients/consumers—in healthcare going forward.

So this news was rather cinematic, and definitely noteworthy, as a somewhat rocky calendar year for the Medicare ACO programs closes out. 2015 will definitely be interesting in this area—and deserves close watching.