CMS Savings Reaffirms the Need for Primary Care Support

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Key Insights

  • Accountable care organizations (ACOs) in the Centers for Medicare and Medicaid Services’ (CMS) Pathways to Success Program saved $1.2 billion in healthcare costs in 2019.
  • The results show how physicians have been able to reduce wasteful healthcare spending while improving patient outcomes throughout the COVID-19 pandemic.
  • Physicians can get involved with an ACO by finding the right partner.

The Rundown

In December 2018, CMS finalized the Pathways to Success Program. The program was meant to be an overhaul of the Medicare Shared Savings Program (MSSP) that placed ACOs on a five-year track to accepting more downside risk.

Pathways to Success incentivized ACOs to “take on real risk while offering them the incentives and flexibility they need to coordinate care and innovate, is an important step forward in how Medicare pays for value.” ACOs who chose to participate in the program had to accept more risk after two years as opposed to MSSP, which allowed ACOs to remain in the program “without taking accountability for healthcare spending” for up to six years.

On September 14, 2020, CMS released the Pathways to Success results which showed that all 541 participating ACOs generated $1.2 billion in shared savings in 2019.

Reaffirming the Critical Importance of Primary Care

Patients with a primary care physician are 19 percent less likely to die prematurely, and the Pathways to Success program illustrates how primary care physicians can continue to provide high-quality care while reducing healthcare costs. However, ACOs faced financial uncertainty with the COVID-19 pandemic.

A study by the Medical Group Management Association (MGMA) shows that 97 percent of independent primary care physicians and providers have “experienced a negative financial impact directly or indirectly related to COVID-19.” On average, independent practices reported a “55 percent decrease in revenue and a 60 percent decrease in patient volume.”

As a result, many primary care physicians closed their offices, compounding the already dire physician shortage. Only 25 percent of medical school graduates choose primary care and over 33 percent of current primary care physicians will be eligible for retirement within the next five years. Concurrently, 48 percent of the United States population is expected to reach age 65 by 2032.

Getting Involved in an ACO

As the healthcare system continues to move toward value-based care, enrolling in an ACO can give physicians an additional advantage in lieu of financial uncertainty: the support of a knowledgeable partner. Many ACOs have tools, technology, and talent — such as telehealth software, care management teams, and a team of billing, coding, revenue cycle management, and other experts — to actively prepare for uncertain situations. 

Physicians in ACOs have been able to leverage these cost-saving benefits to anticipate future COVID-19 outbreaks, which potentially saved many lives. With additional financial support, physicians had the knowledge they needed to continue running their practices throughout the pandemic.


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