Medicare Shared Savings Program: Enhancing Value-Based Care and Reducing Costs

The Medicare Shared Savings Program (MSSP) is a pivotal initiative by the Centers for Medicare and Medicaid Services, aimed at improving quality and reducing healthcare costs. As part of the Affordable Care Act, the MSSP offers a voluntary framework for Accountable Care Organizations (ACOs) to deliver value-based care. Currently, 476 ACOs are engaged in MSSP, as highlighted during the "Embedding Clinical Intelligence to Transform Medicare Shared Savings Program Outcomes at Scale" session at the HIMSS Global Health Conference & Exhibition.

Andrew Albano, vice president at Atlantic Health System, reported notable financial outcomes, including $15 million in shared savings for their ACO in 2024 and $1 million in quality-based incentives. This success, achieved in collaboration with Innovaccer, underscores the use of artificial intelligence for effective patient data consolidation, contributing to a positive return on investment in the first year of full performance.

Despite these achievements, challenges such as integrating clinical intelligence into existing workflows persist, according to Dr. Brian Silverstein of Innovaccer. He emphasized the increased time demands on physicians and the complexity of integrating intelligence across over 120 electronic health records systems. Moreover, patient attribution and varying payer quality metrics add layers of complexity. Albano highlighted the importance of reducing administrative burdens to combat physician burnout, prevalent among 45-50% of clinicians. Atlantic Health’s collaborative approach with Innovaccer resulted in a 22.1% improvement in closing quality care gaps, demonstrating the critical role of clinical intelligence in enhancing care delivery and achieving cost savings.

Atlantic Health, which operates seven hospitals in Morristown, New Jersey, manages the Atlantic ACO and partners with Optimus ACO and Premier ACO, serving over 81,000 lives within the Medicare Shared Savings Program.