Frequently Asked Questions: Medicare Shared Savings Program (MSSP)
Navigating healthcare systems, especially Medicare-related programs, can be complex and overwhelming for patients. To demystify some of the key aspects of the Medicare Shared Savings Program (MSSP) and the role of Accountable Care Organizations (ACOs) within it, the Centers for Medicare & Medicaid Services (CMS) has developed a set of Beneficiary Notification FAQs. These frequently asked questions (FAQs) are designed specifically for patients to clarify important aspects such as the MSSP, ACOs, and the Beneficiary Notice they may receive.
The Medicare Shared Savings Program (Shared Savings Program) is a unique initiative that allows healthcare providers and suppliers, including physicians and hospitals, to form ACOs. These ACOs take responsibility for the quality, cost, and overall care experience provided to patients enrolled in Original Medicare. This innovative payment model promotes coordinated care, efficient services, and high-quality healthcare outcomes.
In this document, we delve into questions commonly asked by patients regarding the MSSP, ACOs, and the Beneficiary Notice they receive as part of these programs. Understanding these concepts empowers our patients to actively participate in their healthcare decisions while ensuring they access comprehensive information about their care coordination efforts under the MSSP.
What is the Medicare Shared Savings Program (MSSP)?
The Medicare Shared Savings Program (Shared Savings Program) offers providers and suppliers, such as physicians, hospitals, and others involved in your care, the opportunity to create an Accountable Care Organization (ACO). An ACO agrees to be held accountable for the quality, cost, and experience of care assigned to patients who have Original Medicare.
The Shared Savings Program is an alternative payment model that promotes accountability for a patient population, coordinates items and services for patients with Original Medicare, and encourages high-quality and efficient services.
- Resource: Medicare Shared Savings Program
What is an ACO?
An Accountable Care Organization (ACO) is a group of doctors, hospitals, and/or other healthcare providers who work together to improve the quality and experience you get.
These organizations help your doctors and other healthcare providers understand your health history and talk to one another about your care and needs. Avoiding repeated tests and unneeded appointments can save you time and money. It may make it easier to spot potential problems before they become more serious — like drug interactions that can happen if one provider isn’t aware of what another has prescribed.
ACO providers communicate with each other and partner with you in making health care decisions. They share information and may use Electronic Health Records (EHRs), so you’ll likely have fewer repeated medical tests and may save time on paperwork.
An ACO won’t limit your choice of healthcare providers. It isn’t a Medicare Advantage Plan, HMO plan, or an insurance plan of any kind. Only people with Original Medicare can be assigned to an ACO within MSSP. If your doctor, hospital, or other provider is part of an ACO, you still have the right to visit any doctor, hospital, or other provider that accepts Medicare at any time, and your Original Medicare benefits won’t change.
- Resource: Medicare ACOs
What is the Beneficiary Notice, and why is the beneficiary receiving it?
As your provider participates in an ACO and you have Original Medicare, you are receiving a written notification to inform you that a group of providers is working together to coordinate your care, improving your health while reducing unnecessary testing and preventing Medicare fraud, waste, or abuse.
The notification also informs you that Medicare allows your healthcare provider’s ACO to request certain information about your care through this care coordination. Securely sharing your data in
this way helps ensure all people involved in your care have access to your health information when and where they need it so they can work together to get the care you need. If you do not want Medicare to share your health care information in this way, you can “opt-out” of this data sharing by calling 1-800-MEDICARE (1-800-633-4227).