MSSP
Medicare Shared Savings Program
Medicare Shared Savings Program (Shared Savings Program) ACOs are groups of doctors, hospitals, and other health care providers who collaborate to give coordinated high-quality care to people with Medicare. They focus on delivering the right care at the right time, while avoiding unnecessary services and medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, the ACO may be eligible to share in the savings it achieves for the Medicare program.
Innovation
Offers a BASIC track with a glide path starting under a one-sided model and progressing to increasing risk, and an ENHANCED track offering the highest level of risk and potential reward.
The Problem
Uncoordinated care, unnecessary services, medical errors, and high growth in health care expenditures.
The Solution
Groups of doctors, hospitals, and other health care providers form Accountable Care Organizations (ACOs) to collaborate and give coordinated high-quality care, focusing on delivering the right care at the right time.
Expected Outcomes
Delivering high-quality care, spending health care dollars more wisely, and lowering the growth in Medicare Parts A and B expenditures while meeting quality performance standards.
Strategy
Promote quality improvement while lowering the growth in health care expenditures.
Model Goals
- Give coordinated high-quality care to people with Medicare
- Deliver the right care at the right time
- Avoid unnecessary services and medical errors
- Lower growth in Medicare Parts A and B expenditures
Patient Eligibility
Medicare fee-for-service (FFS) beneficiaries assigned to the ACO.
- Must be a Medicare fee-for-service (FFS) beneficiary
- Can voluntarily align with a primary clinician on Medicare.gov
Provider Eligibility
Medicare-enrolled providers and suppliers must form or join an ACO that applies and is accepted to the program.
- Must be Medicare-enrolled providers and suppliers
- Must form or join an ACO
- ACO must have at least 5,000 Medicare FFS beneficiaries assigned in each benchmark year
- Must agree to participate for a period of no less than five years
- Must have a designated compliance official and a detailed compliance plan
- Must maintain a current Electronic Funds Transfer Authorization Agreement (Form CMS-588)
- TINs billing for primary care services must be exclusive to a single Shared Savings Program ACO
Care Categories
Primary Care
Performance Metrics
Hospital-wide, 30-Day, All-cause Unplanned Readmission (HWR) Measure
Measures all-cause, unplanned hospital-wide readmissions for MIPS Groups
Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions (MCC)
Measures all-cause unplanned admissions for patients with multiple chronic conditions
Alternative Payment Model (APM) Performance Pathway (APP) Plus quality measure set
Quality measure set used to determine shared savings and shared losses
Operational Friction
Identified risk vectors and execution hurdles based on model structure.
MSSP attribution is primarily based on the plurality of primary care services, meaning ACOs must proactively engage patients in primary care to secure attribution and influence their total cost of care.
To control the total cost of care and perform well on the APP Plus quality measure set, ACOs need real-time visibility into patient utilization across the entire continuum.
While MSSP is a population-based model, managing high-cost episodes like elective surgeries or chronic disease exacerbations within the performance year is critical to staying below the historical benchmark.
MSSP requires coordinated action between primary care, specialists, and hospitals, but legacy fee-for-service incentives often drive specialists and hospitals toward higher utilization.
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