Health Care Matters | August September 5
MSSP Performance Year 2024 Results
The Medicare Shared Savings Program hit record performance in 2024, with 75% of the 476 participating ACOs earning performance payments totaling $4.1 billion while generating $2.4 billion in Medicare savings. ACOs achieved $241 net per capita savings compared to $207 in 2023, with primary care-heavy ACOs significantly outperforming those with fewer PCPs ($401 vs $219 in net per capita savings). Quality metrics also improved across key health indicators including blood pressure control, diabetes management, and depression screening, with ACOs consistently outperforming comparable physician groups on patient experience measures. Read here.
Why It Matters
This record performance demonstrates the Shared Savings Program's maturation and continues the trend that ACOs with higher primary care concentrations significantly outperform their peers, but participating organizations face a critical transition ahead. Starting in 2025, ACOs must report quality measures via Medicare CQMs, MIPS CQMs, or eCQMs instead of the CMS Web Interface (sunsetted in 2024), which could create technical challenges and potentially lower quality scores that impact shared savings moving forward. The superior performance of primary care-dominant ACOs creates strategic tension with CMS’ broader specialist integration goals and may prompt ACOs to reconsider their provider mix. The proposed rule changes also shorten the one-sided risk period from to 7 to 5 years, with the goal of accelerating ACOs' move to downside risk but may cause some more cautious ACOs to exit.
CMS Announces Changes to AHEAD
The CMS Innovation Center has announced updates to its Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model, extending the program through December 31, 2035, with changes taking effect in January 2026. The revised model introduces new requirements for participating states to implement at least two policies promoting health care market choice and competition, while also mandating Population Health Accountability Plans focused on preventive care and chronic disease prevention. Most notably, AHEAD will now bring total cost of care accountability to all Original Medicare beneficiaries in participating regions through a novel geographic attribution system for beneficiaries not already in other CMS accountable care programs, creating new risk-bearing Geographic Entities with enhanced flexibilities and two-sided risk arrangements. Read here.
Why It Matters
The new AHEAD model weaves together primary care investment, hospital global budgets and geographic accountability- a complex mix that could transform health care ecosystems within a state but will hinge on how all of these moving parts are aligned in practice. The upcoming application cycle presents a strategic opportunity for states that had been preparing for the now-canceled Making Care Primary (MCP) initiative. AHEAD's primary care investment requirements and population health focus align closely with the primary care transformation goals of MCP but the AHEAD model will require significantly more engagement and infrastructure across all healthcare stakeholders with its unique model components. Notably, the geographic attribution approach was originally slated to be a key component of the scrapped Geographic track of the Global and Professional Direct Contracting (GPDC) model, making its integration into AHEAD a logical evolution of CMS's geographic value-based care strategy that appeared during the first Trump administration. Similar to GPDC, Geo AHEAD allows non-provider-led organizations like health plans, and technology companies to become Geo entities in addition to traditional provider groups. Geo AHEAD entities also submit a discounted bid against a CMS TCOC benchmark which has some parallels to Medicare Advantage and allows CMS to lock in savings at the start. This new approach could serve as a signal for future ACO models out of the Innovation Center.
Look for the Helpers: Cooking Up Change: UT Southwestern's Groundbreaking Culinary Medicine Program
Dr. Jaclyn Albin and her team at UT Southwestern Medical Center created the nation's first insurance-reimbursable culinary medicine service line, combining physician care with registered dietitian expertise to help patients with chronic diseases like diabetes and hypertension learn practical cooking and nutrition skills. Their innovative three-phase approach, from electronic consultations to one-on-one clinic visits to group cooking classes in community kitchens, achieved a 99.7% insurance collection rate while serving primarily African American women in underserved Dallas communities. With 387 referrals in just 2.5 years and 92% patient satisfaction, this model demonstrates how food-as-medicine interventions can be successfully integrated into standard health care delivery. Read here.
What We Are Reading
Medicaid's Next Chapter
The National Association of Medicaid Directors (NAMD) reports that Medicaid programs are facing growing state budget pressures while simultaneously working to implement the Medicaid provisions of the OBBBA, which will reshape eligibility requirements and payment structures over the next decade, particularly affecting states that expanded Medicaid under the Affordable Care Act. Read here.
For States With Cost Growth Targets, 2023 Spending Growth Was High Across The Board
According to Health Affairs, all five states with cost growth targets (Connecticut, Delaware, Massachusetts, Oregon, and Rhode Island) far exceeded their 2023 health care spending growth targets, with increases ranging from 5.2% to 9.1% compared to targets near 3%, driven by rising costs across all markets (commercial, Medicare, and Medicaid) and all service categories including significant increases in prescription drugs and hospital outpatient services. Read here.
Implementing High-Quality Primary Care: A Policy Menu for States
The Milbank Memorial Fund and National Academy for State Health Policy released a comprehensive policy menu for states to strengthen primary care systems in response to anticipated coverage losses and budget pressures from the OBBBA, outlining five priority areas including making primary care a policy priority, increasing and reforming payment models, improving access, expanding the workforce, and building capacity for whole-person care. Read here.
What We Are Writing
The Rural Health Crisis Requires More Than Money - It Demands Strategy
Rural hospitals and clinics continue to close, straining access to essential services for millions of Americans. Federal funding through the new $50 billion Rural Health Transformation Program gives states resources to address payment models, workforce shortages, and access challenges, but real progress will depend on pairing dollars with strategies that make rural systems more sustainable. Read more on our blog to see what this means for states and rural communities.
What We Are Attending
Connect and learn about ACOs and other value-based care models on October 8-10 at the NAACOS Fall 2025 Conference in D.C.! The agenda features expert-led sessions, including CMS leaders Chris Klomp and Abe Sutton and Dr. Pippa Shulman of DispatchHealth, a pioneer in delivering acute care in the home. The event offers networking for participants, speakers, and vendors to share ideas, explore partnerships, and gain insights. Register for the in-person conference with code 'HCMEarlyRate' to receive a discount of $300 per person or for the live webcast with code 'HCMVirtualEarly' for a discount of $100. For registration questions or issues, please contact conference@naacos.com.
Call for Nominations
The Department of Health and Human Services has established a new health care advisory committee to deliver strategic recommendations on reforming care delivery and financing across federal health programs. Health care professionals with expertise in chronic disease prevention, health care financing, and delivery system reform are encouraged to apply or be nominated within 30 days of the Federal Register notice. Read here.
Pop Health Podcast
Designing Maternity APMs That Work: Lessons from the Field
In this episode, Coral’s Kate Freeman and Trevor Abeyta talk with Megan Burns and Carol Sakala about CMS’s Transforming Maternal Health (TMaH) model, lessons from value-based maternity care, and strategies states can use to improve maternal health outcomes.