New data show that the Medicare Shared Savings Program (MSSP) will see participation remain steady for 2020 with 517 accountable care organizations (ACOs) taking part this year, down one from last year but off from the high-water mark of 561 ACOs two years ago, according to the National Association of ACOs (NAACOS).

This fresh report comes at a time an increasing number of long term and post-acute care providers are exploring value-based care options, be they via ACO membership or starting health insurance plans under the Medicare Advantage program, among other alternatives.

For the ACO universe, while the number of organizations is flat in 2020 for the MSSP, there are 11.2 million beneficiaries being cared for by ACOs, the most ever, NAACOS said.

But, the outlook for ACOs in the MSSP is clouded by the fact that in 2020 just 35 Shared Savings Program ACOs will enter into their first contract with the Centers for Medicare & Medicaid Services (CMS). Between 2012 and 2018, the program averaged 107 new ACOs annually.

“Last year was the first time the program saw a drop in overall participation when just 41 new ACOs joined,” NAACOS said.

In the fall of 2018, CMS overhauled the Shared Savings Program to force ACOs to take on risk sooner while at the same time reducing the portion of savings ACOs can keep. NAACOS said it and other health provider associations cautioned that the changes could hinder Medicare’s move to value-based payment by hindering participation in a voluntary program.

“ACOs have had the greatest success of any of Medicare’s payment reform efforts,” said Clif Gaus, president and chief executive officer of NAACOS. “If interest in ACOs dwindles, then doctors and hospitals will fall back into a fragmented, fee-for-service system, and any momentum to transform our health system will be lost.”

Amid the discussion on how the MSSP will fare, NAACOS said data show ACOs are reducing Medicare spending, with the organizations collectively saving Medicare $1.7 billion in 2018 alone, and $739 million after accounting for shared savings bonuses and collecting shared loss payments.

Last year, NAACOS said the Medicare Payment Advisory Commission reported that MSSP reduced spending between 1 and 2 percent from 2013 to 2016, which equals tens of billions of dollars on an annual basis. An analysis commissioned by NAACOS showed $3.53 billion in overall savings and more than $755 million in net savings, after paying shared savings to ACOs.

Medicare’s most advanced, greatest risk-taking ACOs, called the Next Generation ACO Model, or Next Gen, collectively saved Medicare $406 million last year. “Importantly, these ACOs also hit an average quality score of 93 percent, improving care for 1.4 million seniors,” NAACOS said. “After accounting for shared savings paid to ACOs for holding down costs and hitting quality targets as well as shared losses paid back to the government, the Next Gen program netted $185 million to Medicare last year alone. These figures are impressive, especially considering this program only had 50 Next Gen ACOs participating last year.”​