The Medicare Shared Savings Program (MSSP), launched by CMS in 2012, has facilitated ACO participation in risk-sharing payment arrangements for Medicare lives. Each ACO’s financial reimbursement is tied to performance against quality, cost, and experience of care based on the risk burden of its eligible Medicare population.
While many provider groups have experience with performance-based contracts, CMS’s risk adjustment process may be less familiar. However, in order to protect benchmark performance and thrive under MSSP, ACOs must develop in-house risk adjustment expertise.
This guide is designed to be a foundational reference for Medicare risk adjustment within MSSP ACOs. It provides an introduction to risk adjustment for ACOs, an overview of the CMS HCC model used in MSSP, key factors for risk adjustment success, and evaluation criteria to help ACO risk adjustment programs improve over time.