The Shared Savings Program is run by the Centers for Medicare & Medicaid Services (CMS). It helps form groups called Accountable Care Organizations (ACOs). These groups include doctors, hospitals, and other healthcare providers who work together. Their goal is to give better, coordinated care to Medicare patients who pay for each service they get. The aim is to give patients the right care at the right time. This avoids repeating services, reduces mistakes, and stops preventable hospital visits.
Providers in these programs are encouraged to focus on quality rather than the number of services they give. When ACOs meet quality and cost goals, they may share money saved for Medicare.
CMS allows many types of providers to join or start an ACO. These include:
Including these different types helps cover many healthcare services like primary care, specialists, hospital care, and care after hospital stays.
Healthcare groups must have official legal setups to join Shared Savings Programs. They usually form ACOs with boards made up of providers and others involved. This setup helps keep them responsible for good care, meeting CMS quality rules, and managing costs.
ACOs must care for a minimum number of Medicare patients, usually a few thousand. This shows they can manage health and risks well for their patient groups.
They must track about 30 quality measures over several years. These include care coordination, patient safety, preventive health, and patient experience. These measures help decide if they qualify for shared savings payments.
To provide coordinated care, groups usually include:
This team works together to manage patients, especially those with ongoing conditions, to improve health and control costs.
Sharing data quickly and accurately is key in these programs. Good Electronic Health Record (EHR) systems with reporting tools and health management parts are needed. These systems help with:
CMS supports using technology to make care coordination smooth, measure results, and meet reporting rules.
CMS offers different options for ACOs to join, based on how much financial risk they want to accept and their abilities:
Entities choose models that fit their size, resources, and technology.
States have Medicaid ACOs in about 11 places. These focus on low-income and vulnerable groups. They follow value-based payment systems like Medicare but often work more on social and behavioral health issues.
Medicaid ACOs usually work with social services to meet wider patient needs. Rules vary by state, but they use shared savings and sometimes shared risk payments to improve care and lower costs. They tend to increase primary care visits, reduce hospital stays, and shorten hospital time. These results can inform Medicare ACOs too.
Good office workflows help administrators and IT staff manage ACOs. Some companies offer phone automation to ease tasks like patient calls, appointment scheduling, and answering questions.
Using artificial intelligence (AI) to handle simple phone calls lets staff focus more on clinical work. This leads to better patient experience and helps meet CMS quality goals.
AI is now part of care management tools. It helps with clinical choices, analyzing patient groups, and finding patients at risk of hospital visits. Care teams can then act fast.
AI also helps by:
These tools help providers do better, meet rules, and reduce manual work.
Joining Shared Savings Programs can be hard. There are big startup and ongoing costs for staff, IT, and systems. Setting up good governance and staying within CMS rules takes work. Legal risks like antitrust laws must be managed carefully.
Providers need technology that works well together to share data smoothly, especially when many groups with different systems are involved. Protecting patient data is also critical.
Healthcare teams must align their work and clinical plans to avoid broken care and meet quality standards.
CMS offers an ACO Learning System with tools, examples, and ways for groups to learn from each other. Public data about ACOs and how they perform is available. This helps groups compare themselves, find ways to improve, and understand changing rules.
The Shared Savings Program needs teamwork across clinical care, management, and technology. Administrators manage compliance, provider work, and care coordination. Practice owners decide if they are ready to join, thinking about risks and investments. IT managers set up and keep running the tech for patient data, quality reporting, and AI tools.
Working well together helps these teams get the most from the programs and improve care for Medicare and Medicaid patients nationwide.
The Medicare Shared Savings Program encourages groups of doctors, hospitals, and other healthcare providers to form Accountable Care Organizations (ACOs) that collaborate to provide coordinated high-quality care to Medicare fee-for-service beneficiaries, emphasizing right care at the right time while avoiding unnecessary services and errors.
An ACO aims to improve the quality, cost efficiency, and overall care experience for an assigned Medicare fee-for-service beneficiary population by promoting accountability and coordination among providers.
The program moves CMS’s payment system away from volume-based care toward value and outcomes by incentivizing providers to invest in high-quality, efficient services and coordinate patient care to reduce unnecessary spending.
Eligible providers include ACO professionals in group practices, networks of individual ACO professionals, hospital partnerships or joint ventures with ACO professionals, hospitals employing ACO professionals, Critical Access Hospitals billing under Method II, Federally Qualified Health Centers, Rural Health Clinics, and selected teaching hospitals.
The program offers different participation tracks that allow ACOs to select arrangements best suited to their organizational structures and risk preferences, ranging from one-sided shared savings to higher-risk, higher-reward models.
ACOs agree to be accountable for the quality, cost, and care experience of their assigned beneficiary population, incentivizing them to deliver coordinated and high-value care while controlling costs.
CMS supports ACOs through model-specific learning systems where ACOs can collaborate, share best practices, and access toolkits and case studies from the CMS Innovation Center to improve patient care delivery.
CMS makes participation and performance data publicly available on Data.CMS.gov, providing transparency about the number, locations, and outcomes of ACOs in the program.
ACOs can be formed by group practices, networks of professionals, hospital-ACO partnerships, Critical Access Hospitals, Federally Qualified Health Centers, Rural Health Clinics, and teaching hospitals, indicating broad inclusion of healthcare providers.
Participation in the Shared Savings Program is voluntary, encouraging providers and suppliers to join ACOs to improve care quality and efficiency for Medicare fee-for-service beneficiaries.
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