Closing the gap in value-based care: Lessons from provider-led ACO experience

Closing the gap in value-based care: Lessons from provider-led ACO experience
Health Affairs; by Clive Fields, Gary M. Jacobs; 8/6/24
Achieving the Centers for Medicare and Medicaid Services’ (CMS’s) goal to bring every Medicare patient into a value-based care (VBC) arrangement by 2030 requires bold action. With six years left to achieve that goal (as of January 2024), only half of current Medicare beneficiaries are aligned with an accountable care organization (ACO) providing care within a VBC arrangement. This gap is large, but accelerated participation and reaching the 2030 goal remain possible. To close the gap, policy makers must apply the lessons learned from the real-world experience of models developed by the Center for Medicare and Medicaid Innovation (the Innovation Center), the Medicare Shared Savings Program (MSSP), and other CMS demonstrations. ACOs participating in the MSSP and alternative payment models developed by the Innovation Center have proven that they can deliver high-quality care, improve the patient experience, and generate savings for Medicare. The Congressional Budget Office has found that physician-led ACOs and ACOs with a larger proportion of primary care providers, as opposed to specialists or clinicians in non-primary care settings, generate greater savings.