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Benchmarking

Reimagining Accountable Care Programs for Medicare

Modernizing Benchmarks to Improve Recruitment, Retention, and Program Integrity

Accountable Care Organizations (ACOs) incentivize health care providers to deliver high-quality and cost-efficient care, rewarding providers by allowing them to share in the savings they create by finding ways to improve health and reduce costs. Savings are achieved by spending less than an assigned benchmark, providing a spending target for providers to meet, assuming quality is at least maintained.

Unfortunately, the way CMS sets these benchmarks does not represent how health care is delivered today. The Medicare Shared Savings Program (MSSP) uses past spending data to set payment limits, and Medicare Advantage uses local Medicare spending to compare costs. These methods can be unfair or outdated, leading some organizations to leave MSSP because they feel the system works against them. Recent changes aimed at improving benchmarking for MSSP payments have made the program more complicated, causing even more concerns and making it harder for new organizations to join. For ACOs to become a market standard, different benchmarking approaches are needed to improve recruitment and retention across Medicare.

By The Numbers

11 Million

number of beneficiaries covered by MSSP ¹

50%

share of Medicare beneficiaries covered by MA ²

$2.1 billion

reported net savings achieved by MSSP in 2023 ³

561 to 517

reduction in number of ACOs participating in the MSSP from 2018 to 2020 ⁴

Redesigning Benchmarking Policies

The Accelerator is building consensus among stakeholders and developing a step-by-step plan to help the Centers for Medicare & Medicaid Services (CMS) improve its benchmarking policies, ultimately lowering costs and improving patient outcomes by increasing participation from high-quality providers. Our approach includes:

Collaborating with ACOs, insurance plans, policymakers, and other experts to find a practical way to improve how Medicare sets payment benchmarks.

Building a feasible plan to define benchmarks based on real experience and inputs from these groups — especially those currently or previously involved in MA or MSSP.