Medicare Shared Savings Program (MSSP)

What is the Medicare Shared Savings Program?

The Medicare Shared Savings Program (MSSP) was established by the Affordable Care Act to address rising healthcare costs and growing concerns of the financial stability of the Medicare program. The Shared Savings Program is a key reform initiative and a new approach to the delivery of health care. The Shared Savings Program facilitates coordination and cooperation among providers to improve the quality of care for Medicare beneficiaries and reduce unnecessary costs. Eligible providers, hospitals, and suppliers may participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO).

What is an ACO?

An ACO is a healthcare organization that implements a care delivery model that ties provider reimbursements to quality metrics and reductions in the total cost of care. The goal is to achieve quality improvements and spending reductions for a specified population. ACOs are formed when doctors, physician assistants, nurse practitioners, clinical nurse specialists, group practices and hospitals join to coordinate patient care. By controlling future healthcare costs while promoting and rewarding quality care, ACOs increase access to affordable health insurance coverage.

Participation in an ACO is voluntary and is not categorized as a Medicare Advantage plan or an HMO. Providers may want to form ACOs and participate in these programs for many reasons, including to maintain or grow their practice and the possibility to share in savings that result from improved care coordination.

An ACO receives multiple benefits from participating

The Centers for Medicare and Medicaid developed the Medicare Shared Savings Program in order to innovate an alternative payment model for ACOs. The key benefits include:

1. Providing accountability for the care of individuals.

2. Helping ensure performance standards on quality of care.

3. Lowering growth in expenditures in health care costs.

4. Promoting coordinated care among physicians and specialists.

5. Developing new infrastructure and care processes.

The program measures ACOs on how well they integrate and coordinate care, improve quality, and reduce healthcare costs. The hope is the MSSP will allow further development of ACOs to care for more Medicare fee-for-service beneficiaries.

There are two ways for an ACO to participate

ACOs can participants in the Medicare Shared Savings Program through:

1. The one-sided model. This is designed for less experienced ACOs, who will share in savings but not in the losses. It is available only for the first three-year agreement period.

2. The two-sided model. This is geared for more experienced ACOs. Participants share both savings and losses. The choice allows participants to pick a model based on their risk appetite and prevents experienced ACOs from taking advantage of the system.

For both options, program participants are required to collect and report on 33 quality measures, including:

• Patient experience survey measures.

• Claims-based measures.

• 22 measures reported via the ACO GPRO web interface.

• The Electronic Health Record (EHR) Incentive Program measure.

  • A maximum of two points can be earned for each scored individual or composite measure, except for the EHR measure.

  • The EHR measure is double weighted and is worth up to 4 points to provide incentive for greater levels of EHR adoption.

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