Medicare Shared Savings Program (MSSP) is utilized today for better health cost management and enhanced quality of health services. ACOs receive payment from Medicare directly related to Part A and B spending and an assessment of its quality. In present times, Medicare Part D spending is excluded and its medication cost is not taken into account. ACO providers may be incentivized for boosting shared savings reducing Part A and B spending and then boost the prescription of Part D drugs. 
 
As per recent year results, compared with non-ACO providers, Part D spending has received a fillip although of a negligible amount after providers enrolled in MSSP. However, the effect died when other ACO providers did not renew MSSP contracts at the same time. 
 
Understanding the ACO effects especially related to Medicare Part D spending and resource utilization will help in assessing the success of ACOs in boosting shared savings and drive health quality in Medicare.
 
Steps to transform Medicare
 
The Medicare debate has tried to veer towards making Medicare sustainable especially its transformation from a fee-for-service system to a value-based system in which doctors are paid when they deliver better health outcomes.
 
A key part of this transformation is that the MSSP can care for beneficiaries with 480 ACOs enrolled in the same program, which will cover 9 million+ Medicare beneficiaries, constituting about 23% of all original beneficiaries.
 
This staggering growth can be attributed to a concentrated effort as it requires millions of dollars to start an ACO. There is a sustainable future for ACOs as they assess regional landmarks to judge their success. Despite the progress, one expects there would be more investment and fine-tuning to strengthen the MSSP especially to transform Medicare to the value-based system.
 
Here are some steps one needs to take for MSSP transformation of medicare:
1. CMS needs to tailor MSSP risk small practices as they are directly connected to the ACO’s financial resources. Any epidemic or disaster can lead to the doom of a well-intentioned practice.
 
2. Second, we need a perfect way to measure the value derived from an MSSP ACO. A difference-in-difference approach can work when the benefits from the present situation is compared with the original medicare plan. 
 
3. The CMS should simplify the program by incorporating changes to the tracks rather than create a new track. 
 
4. One should also have a roadmap for transitioning from medicare shared savings program to capitated payments that are reserved under Medicare Advantage. Here, different segments of medical costs are capitated over time, as CMS will process claims and even provide stop-loss reinsurance. The clear transition to risk-adjusted Medicare Advantage premiums is important in this regard.
 
If CMS continues to improve MSSP, there will be more investments, which in turn will strengthen Medicare benefits for everyone.