All-payer value-based contracting in organizations with Medicare ACOs

Area of Science:

• Health Policy
• Healthcare Management
• Value-Based Care

Background:

• The Medicare Shared Savings Program (MSSP) encourages accountable care organizations (ACOs) to adopt value-based care models.
• Understanding the extent of non-Medicare value-based contracting among MSSP participants is crucial for assessing broader healthcare transformation.

Purpose of the Study:

• To measure the prevalence of non-Medicare value-based contracting among MSSP participants.
• To determine the extent of participation in contracts with downside financial risk within these organizations.

Main Methods:

• Cross-sectional analysis of a 2022 survey of 100 organizations participating in the MSSP.
• Analysis of covered lives distribution across various value-based contract types (Medicare ACO, Medicare Advantage, commercial, Medicaid) and risk arrangements.
• Comparison of contract prevalence and risk structures with 2018 data.

Main Results:

• MSSP participants reported 15.5 million covered lives in value-based contracts.
• Approximately 75% of respondents had value-based contracts with commercial and Medicare Advantage plans.
• Seventy percent of covered lives in Medicare ACO contracts included downside risk, compared to 51% in commercial and 45% in Medicare Advantage plans.
• The proportion of respondents in value-based Medicare Advantage contracts doubled since 2018, and commercial contracts rose by half.

Conclusions:

• MSSP participants have significantly expanded their engagement in value-based contracts beyond traditional Medicare.
• Medicare ACO contracts demonstrate a higher proportion of covered lives with downside risk compared to commercial or Medicare Advantage contracts.