The MSSP is a value-based payment model established by the Centers for Medicare & Medicaid Services (CMS) in the United States. It aims to promote accountable care organizations (ACOs) to improve the quality of care for Medicare beneficiaries while reducing healthcare costs. Participating ACOs agree to be accountable for the quality, cost, and overall care of their assigned Medicare beneficiaries.
A group of healthcare providers, such as hospitals, physicians, and other healthcare professionals, who voluntarily come together to coordinate care for patients. ACOs aim to improve care quality and reduce unnecessary costs by focusing on patient outcomes rather than the volume of services provided.
An individual who is enrolled in the Medicare program and is eligible to receive healthcare benefits through Medicare.
Performance indicators used to assess the quality of care provided by healthcare providers or organizations. These measures can include patient outcomes, patient experience, adherence to clinical guidelines, and preventive care services.
Reductions in healthcare expenditures achieved through strategies such as improved care coordination, preventive care, and reduction of unnecessary medical services. In the context of the MSSP, ACOs may share in the savings they generate for Medicare if they meet certain quality and cost targets.
A standard or reference point used to evaluate the performance of ACOs in the MSSP. The benchmark represents the estimated average Medicare spending for the beneficiaries attributed to the ACO if it were not participating in the program. ACOs must achieve savings compared to this benchmark to be eligible for shared savings.
The portion of cost savings achieved by an ACO in the MSSP that is shared with Medicare. ACOs that meet quality and savings targets may receive a percentage of the savings they generate, incentivizing them to improve care efficiency and quality.
The process of assigning Medicare beneficiaries to an ACO to evaluate performance and calculate shared savings. Beneficiaries are attributed based on their primary care provider’s participation in the ACO and their utilization of services.
The annual period during which an ACO’s performance is evaluated in the MSSP. Performance years typically align with the calendar year, and ACOs must meet quality and cost targets to qualify for shared savings.
A method used to account for differences in the health status of patients when evaluating ACO performance and calculating benchmarks. Risk adjustment ensures that ACOs are not unfairly penalized for caring for sicker patients and promotes fair comparisons of performance across different populations.