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Area of Science:

  • Health Economics
  • Healthcare Policy
  • Public Health

Background:

  • The Medicare Shared Savings Program (MSSP) aims to control healthcare costs through Accountable Care Organizations (ACOs).
  • Regional spending adjustments to ACO benchmarks were introduced in 2017, influencing provider participation.
  • These changes favored ACOs and practices with lower baseline spending compared to their region.

Purpose of the Study:

  • To analyze how providers responded to new MSSP incentives introduced in 2017.
  • To characterize changes in ACO and practice participation based on spending levels.
  • To assess the impact of regional spending adjustments on MSSP composition.

Main Methods:

  • Isolated changes in provider composition within the MSSP.
  • Analyzed shifts in ACO and practice participation before and after 2017.
  • Examined entry, exit, and reconfiguration patterns of participants based on baseline spending.

Main Results:

  • Post-2017 MSSP composition shifted towards providers with lower regional baseline spending.
  • This shift occurred through new lower-spending ACO entries, higher-spending ACO exits, and internal practice reconfigurations.
  • Participation patterns differed significantly across various ACO types.

Conclusions:

  • The MSSP's composition increasingly reflects a selection of lower-spending providers.
  • While direct causality is complex, these patterns suggest a response to the 2017 benchmarking changes.
  • The disproportionate participation of lower-spending providers highlights potential costs and the need for ACO benchmarking reform.