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ABSTRACT
Objectives: To measure the prevalence of non-Medicare value-based contracting and participation in contracts with downside risk among organizations participating in the Medicare Shared Savings Program (MSSP).
Study Design: Cross-sectional analysis of 2022 accountable care organization (ACO) survey.
Methods: The author analyzed surveys from 100 organizations participating in the MSSP that reported the number of covered lives they have in value-based contracts in traditional Medicare (ACOs), Medicare Advantage (MA), commercial payers, Medicaid managed care organizations, Medicaid, and direct-to-employer arrangements. We analyzed the distribution of covered lives across shared-savings, shared-risk, and full-risk contracts and analyzed changes between 2018 and 2022.
Results: Respondents reported 15.5 million covered lives in value-based contracts. All respondents have Medicare ACO contracts, and roughly 75% reported value-based contracts with commercial and MA plans. Approximately one-third reported such contracts with Medicaid managed care plans. Seventy percent of covered lives in respondents' Medicare ACO contracts included downside risk for losses compared with 51% of lives in commercial plans and 45% in MA plans. Compared with a similar 2018 survey, the proportion of respondents in value-based MA contracts doubled, and the proportion in commercial contracts rose by half.
Conclusions: Organizations that participate in Medicare ACO models have substantially increased their participation in value-based contracts with other payers. They reported a higher proportion of Medicare ACO covered lives in downside risk arrangements than in commercial or MA contracts.
Am J Manag Care. 2023;29(11):601-604. https://doi.org/10.37765/ajmc.2023.89456
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Takeaway Points
Little public information is available about value-based contracting outside traditional Medicare. This article provides all-payer contracting details from a 2022 survey of 100 organizations with Medicare accountable care organizations (ACOs).
* Approximately 75% of respondents have value-based contracts with commercial and Medicare Advantage (MA) plans.
* The proportion of covered lives with downside risk was 70% in Medicare ACOs, 51% in commercial plans, and 45% in MA.
* The proportion of respondents in value-based MA and commercial contracts rose by 100% and 50%, respectively, since 2018.
* Medicare ACOs have increased value-based contracting outside traditional Medicare but still take less downside risk with these other payers.
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The health policy community has encouraged the adoption of value-based payment models that hold health care organizations accountable for the total cost of care. In 2015, HHS Secretary Sylvia M. Burwell announced...