Congratulations Accountable Care Organizations (ACOs) for Making Shared Savings

MSSP ACOs totaled more than $2 Billion in shared savings in 2020; Salient Healthcare clients averaged more than $4.6 Million in shared savings, nearly double the national average for the second year in a row!

On August 25, 2020, CMS released financial and quality performance results for the Medicare Shared Savings Program (MSSP) Performance Year 2020.  The 513 MSSP ACOs collectively produced $4.1 billion in gross savings and hit an average quality score of 97.8 percent.  To date, this is the largest annual savings for the program, almost doubling last year’s $2.6 billion in savings.

Let’s discuss the impacts that COVID-19 had on ACOs for PY 2020. An April 2020 survey, conducted by The National Association of ACOs (NAACOS), found that 77 percent of ACOs reported they were “very concerned” about the impact of COVID-19 on their ACO’s 2020 performance. In response to these concerns, CMS released a policy that removed the COVID-19 episode from ACO expenditures, which significantly helped many ACOs generate savings.

The same survey found that 56 percent of risk-based MSSP ACOs reported they were likely to leave the MSSP in response to concerns about having to potentially repay losses in 2020 because of COVID-19. Given these concerns, and the need for ACOs to focus on taking care of patients during the Public Health Emergency, CMS waived all shared losses for at-risk ACOs in 2020.

While many ACOs have been hesitant to take on downside risk, especially given the impacts of COVID-19, the ACOs that did take downside risk generated more savings than the ACOs that chose not to.

  • 75 percent of one-sided ACOs produced savings; 55 percent earned shared savings.
  • 97 percent of two-sided ACOs produced savings; 88 percent earned shared savings.

Salient Healthcare is proud to have played a part in helping ACOs succeed. MSSP participants showed a shared savings of $215.15 per beneficiary, however, Salient clients generated an average of $417.27 per beneficiary in shared savings—nearly double! The best way to ensure you are practicing good population health is properly managing your population using data analytics. Consider monitoring your performance using the Salient Healthcare Solution – our Key Performance Indicators, and our expertise in the industry has led to significant success for our clients. Early in 2021, Salient released an enhancement that helps ACOs track their COVID-19 episodes, and the ability to remove these expenditures, from ACO financial calculations, following the CMS logic.

While 2020 had many success stories for the MSSP, it is likely that future years will see a lower shared savings rate. Many patients postponed their care in 2020, which may account for the significantly lower utilization, and therefore, spend. However, it is likely that these patients will still seek care in the future due to exacerbations. Additionally, patients with chronic conditions may see significantly long-term impacts of delaying care. Furthermore, patients may experience mental health issues as a result of the pandemic, which are correlated with increased expenditures. I’d encourage ACOs to re-invest their shared savings into chronic care management programs to continue to improve patient outcomes in the future.

Congratulations to all ACOs that generated shared savings in 2020, and we hope to see even more shared savings, and higher quality scores, in 2021!

Maria Nikol

About the Author


Senior Business Consultant

Maria Nikol is a senior business consultant with 10 years of experience in healthcare operations and healthcare strategy. Her specialization includes process improvement and the application of emerging models of healthcare delivery such as Patient-Centered Medical Homes and Accountable Care Organizations. She holds a Master of Jurisprudence in Health Law from Widener University and a Bachelor of Science in Pharmaceutical Marketing and Management from the University of the Sciences in Philadelphia.

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