21% Total Medicare Beneficiaries (2017): 58 million

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1 About 1 in 5 Medicare beneficiaries are receiving care from ACOs or medical home models in 2017 Medicare Advantage: 19 million beneficiaries 33% 21% ACOs and Medical Homes 12 million beneficiaries Traditional Medicare: 39 million beneficiaries (67%) Total Medicare Beneficiaries (2017): 58 million NOTE: Medicare beneficiaries attributed to both an ACO and a medical home may be double counted. SOURCES: CMS, Fast Facts: All Medicare Shared Savings Program ACOs (January 2017), Comprehensive Primary Care Plus, and Independence at Home Demonstration Corrected Performance Year 2 Results (January 2017); KFF analysis of March 2017 CMS Medicare Advantage enrollment file.

2 Medicare s net savings on ACOs was $47 million below benchmarks after accounting for shared savings/losses in 2016 ACO financial performance results, relative to benchmark: $796 million $0 + Medicare payments to ACOs for shared savings + ACO payments to Medicare for shared losses -$29 million = Net Medicare savings -$47 million Medicare savings on services -$768 million NOTES: Analysis includes MSSP, Pioneer, and Next Generation ACOs; excludes Comprehensive ESRD Care Model. SOURCES: Kaiser Family Foundation analysis of 2016 results for MSSP, Pioneer, and Next Generation ACOs public use files and unpublished CMS data.

3 More than half of MSSP ACOs achieved Medicare savings relative to their benchmarks, but less than a third saved enough to receive any shared savings payments No savings 44% Received shared savings 31% Not eligible for shared savings 25% Relative to benchmarks: Increased Medicare spending on services Lowered Medicare spending on services 432 Medicare Shared Savings (MSSP) ACOs NOTE: Results include MSSP ACO Tracks 1, 2, and 3. SOURCE: Kaiser Family Foundation analysis of the 2016 Medicare Shared Savings Program Accountable Care Organizations dataset.

4 Net Savings Net Costs ACOs that accepted risk in 2016 produced net Medicare savings relative to their benchmarks, unlike no-risk ACOs Net Medicare spending on ACO models, in millions: ALL ACOs No-risk ACOs At-risk ACOs MSSP Track 1 MSSP Track 2 MSSP Track 3 Pioneer Next Generation $72m $0 -$18m -$14m -$24m -$47m -$63m No. of ACOs: NOTES: Analysis excludes Comprehensive ESRD Care Model. AP and AIM ACOs are included in their respective MSSP tracks. SOURCES: Kaiser Family Foundation analysis of 2016 public use files for MSSP, Pioneer, and Next Gen ACOs and unpublished CMS data.

5 Accountable Care Organization (ACO) Models (2017) Medicare Shared Savings Program (MSSP) Track 1 MSSP Track 2 MSSP Track 3 ACO Investment Model (MSSP) Next Generation ACOs Source: Map data downloaded August 16, 2017 from CMS, Where Innovation is Happening, and 2017 Medicare Shared Savings Program Accountable Care Organizations Map. MSSP Track 1+ location data is not yet available.

6 Two states in the MAPCP medical home model achieved statistically significant net Medicare savings; Michigan accounted for the largest share, by far ( ) Net Medicare spending in millions, relative to comparison group: Minnesota Maine Rhode Island N. Carolina New York Pennsylvania Vermont Michigan $87.9 $64.9* $0 $14.4 $14.2 $9.6 -$24.2 -$63.9* NOTES: *Statistically significant difference from comparison group (p < 0.10). Comparison groups were comprised of beneficiaries in non- MAPCP patient-centered medical homes, except in Minnesota, for which the comparison group was comprised of beneficiaries not in a patient-centered medical home. SOURCE: RTI International, Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, June $229.8*

7 Medicare paid more than half of all care management fees for CPC medical homes in 2015, but accounted for less than one third of all patients reflects higher expected medical complexity among Medicare beneficiaries CPC Beneficiaries Care Management Fees Medicare (29%) Medicaid (7%) Medicare (55%) Commercial Payers (64%) Medicaid (3%) Commercial Payers (42%) Total Attributed patients: 1.15 million Total Fees: $104.4 million Median: $175,775/practice SOURCES: CMS, Comprehensive Primary Care Initiative Fast Facts (2016) and Mathematica Policy Research, Evaluation of the Comprehensive Primary Care Initiative: Third Annual Report, December 2016.

8 Medical Home Models (2017) Comprehensive Primary Care Plus Independence at Home Source: Map data downloaded August 16, 2017 from CMS, Where Innovation is Happening.

9 Major joint replacements of lower extremity (hips/knees) was the only clinical group that achieved statistically significant Medicare savings per episode in BPCI Model 2 Difference in Medicare spending per episode, relative to comparison group, among the 10 clinical groups with the highest number of episodes): $0 -$253 -$224 -$164 -$142 -$114 -$59 -$32 $135 -$1,032 -$1,273* No. of Episodes: 40,974 2,591 13,552 9,523 2,823 3,802 10,484 8,286 2,927 2,394 NOTES: *Statistically significant difference from comparison group (p < 0.05). Services included in BPCI Model 2 bundle: inpatient care, physician care, post-acute care, and all related services. Of the 23 clinical groups that had enough episodes for statistical analysis, the only group with statistically significant results was Major Joint Replacement of the Lower Extremity. SOURCE: KFF analysis of results shown in The Lewin Group, CMS Bundled Payments for Care Improvement Initiative Models 2-4: Year 3 Evaluation & Monitoring Annual Report, October 2017.

10 For major lower joint replacements (hips/knees) episodes within BPCI Model 2, Medicare spending for post-acute care declined for facility-based care (SNFs and IRFs), but not for home health care Difference in BPCI participants Medicare spending for major lower joint replacements relative to comparison group, per episode, years 1 and 2: $0 Total for Episode Skilled Nursing Facilities (SNF) Inpatient Rehab. Facilities (IRF) Home Health $92 -$435* -$711* -$1,273* NOTES: *Statistically significant difference from comparison group (p < 0.05). Services included in BPCI Model 2 payments: inpatient care, physician care, post-acute care, and all related services. SOURCE: KFF analysis of results shown in The Lewin Group, CMS Bundled Payments for Care Improvement Initiative Models 2-4: Year 3 Evaluation & Monitoring Annual Report, October 2017.

11 Bundled Payment Models (2017) Bundled Payments for Care Improvement (BPCI) Model 2 BPCI Model 3 BPCI Model 4 Oncology Care Model Episode Payment Models (AMI, CABG, SHFFT) Cardiac Rehabilitation Incentive Payment Model Comprehensive Care for Joint Replacement Model Source: Map data downloaded August 16, 2017 from CMS, Where Innovation is Happening.