As the nation’s largest health-care payer, accounting for more than one-fifth of all health-care dollars spent in the United States, Medicare plays a critical role in shifting the health-care system away from fee-for-service, which incentivizes quantity of care, and toward value-based care, which incentivizes high-quality care and smarter spending. The passage of the Affordable Care Act acted as a catalyst for new payment and care delivery models that reward better care, wiser spending, and overall health. Medicare has made significant progress in moving toward value and advancing accountable care over the last decade.
The Medicare Shared Savings Program in Traditional Medicare brings together groups of doctors, hospitals, and other health care providers as Accountable Care Organizations (ACOs) to take responsibility for improving care quality, care coordination, and health outcomes for groups of beneficiaries. From recruiting its first health care provider participants in 2011, the Shared Savings Program has grown to become one of the country’s largest value-based purchasing programmes, covering more than 11 million people and over 525,000 participating clinicians. Physician groups participating in the Shared Savings Program have higher quality ratings than their non-participating counterparts, and the programme has saved the Medicare Part B Trust Fund $6 billion or more over the last five years.
A good example of an accountable care relationship is the one that exists between a Shared Savings Program Accountable Care Organization (ACO) and their assigned beneficiaries. In Medicare Advantage (MA), which accounts for 45 percent of Medicare enrollment, an increasing proportion of payments to health care providers is made under advanced value-based arrangements.