The Medicare Shared Savings Program

Delivering technical assistance to help improve health care and control costs through Accountable Care Organizations

By Melissa Morley

Medicare provides insurance to approximately 55 million Americans. Most beneficiaries are 65 or older, and many receive their health care from multiple doctors, hospitals, and other providers.

For more than 20 years, RTI has worked with the Medicare program to develop and refine the present-day Accountable Care Organization (ACO) model. ACOs are modeled to create incentives for providers to voluntarily work together to deliver high-quality, coordinated care to patients while reducing costs. Successful ACOs put patients at the center of the health care system by making sure they get the care they need while avoiding unnecessary and wasteful services. Patients benefit from receiving higher-quality and coordinated care while maintaining the freedom to choose their medical care providers, and providers benefit by sharing in the cost savings that are generated by the ACO.

It is a complex endeavor to make ACOs simultaneously work for the Medicare program, health care providers, and patients. RTI’s project team incorporates a diverse array of disciplines and perspectives into our approach including experts in health policy, economics, medical care, quality measurement, and risk adjustment. For the past 5 years, we have worked with the Centers for Medicare & Medicaid Services (CMS) on the Medicare Shared Savings Program (MSSP) to design and implement critical operational elements to help make ACOs successful. In 2016, MSSP included 432 participating ACOs serving more than 7 million Medicare beneficiaries.

In 2015, 31% of MSSP ACOs generated savings above their minimum savings target compared to 28% in 2014 and 26% in 2013. MSSP ACOs that reported quality in both 2014 and 2015 improved on 84% of the quality measures reported in both years. Furthermore, evidence shows that as ACOs gain experience, they tend to perform better. The total savings generated by ACOs also increased from more than $411 million in 2014 to more than $466 million in 2015.

ACOs are delivering higher-quality care to more and more Medicare patients each year. As ACOs have demonstrated increasing success, RTI’s role in supporting the CMS and ACO programs has continued to grow.