Financial Benchmarking

Background
ACO performance is measured using a multi-step process that evaluates an ACO’s effectiveness in lowering expenditures for a group of assigned beneficiaries against a financial benchmark reflective to historical costs. Benchmarks are initially established for new ACOs, updated during agreement periods and reset or rebased when ACOs enter subsequent agreement periods. Benchmarking is fundamental to ACOs’ success and a source of NAACOS advocacy in the past. CMS has updated its benchmarking methodology multiple times, most notably by introducing regional expenditure data over the course of ACO agreement periods. 

Overview

• MSSP benchmarking methodology is outlined in this CMS resource
   
• CMS regulations governing benchmarking methodology are here and here
  
  
• CMS webinar slides on ACO REACH’s financial methodology

News and Advocacy 

• May 2022 NAACOS webinar: “A Look into MSSP Benchmark Report Trends and Implications” 
  • NAACOS and 11 organizations write CMS to request ACOs be given the option to select pre-pandemic years to set benchmarks
• NAACOS and 12 others write Congress in support of the Accountable Care In Rural America Act (H.R. 3746)
  • One-page summary of the “Rural Glitch” issue and press release on the letter
• NAACOS in-depth analysis of the final Pathways to Success rule, which included several changes to benchmarking methodology
• Frequently Asked Questions on the final Pathways to Success Rule
  
• NAACOS resource on the Effect of Medicare Classifications of ESRD Beneficiaries on ACO Expenditures>
  
  
• NAACOS Summary of Final 2016 MSSP Benchmarking Rule 
  
  
• NAACOS and Other Prominent Organizations Submit Comments to CMS on Regional Benchmarking NPRM 
  
  
• NAACOS comments Health Care Payment Learning & Action Network Financial Benchmarking White Paper

 indicates members only resource.