The Medicare Shared Savings Program (MSSP) will have 561 accountable care organizations (ACOs) participating in 2018, including 124 new entrants into the program, covering a total of 10.5 million assigned beneficiaries, according to CMS.

The program overall has grown each year since its launch in 2012 when 220 ACOs covering 3.2 million beneficiaries. In 2017, 480 ACOs participated covering nine million beneficiaries. As in past years, the vast majority of ACOs (82 percent overall) are in the upside-only Track 1 of the program, but the share of those taking on downside risk increased of the new risk-based Track 1+ model.

Eighteen percent of all MSSP ACOs will be assuming risk in 2018, with 55 participating in Track 1+, eight in Track 2 and 38 in Track 3, all of which qualify as Advanced Alternative Payment Models (AAPMs) under the Quality Payment Program introduced by the Medicare Access and CHIP Reauthorization Act (MACRA).

“We are pleased to see more ACOs moving into two-sided models,” said Clif Gaus, ScD, president and CEO of the National Association of ACOs. “This growth is an encouraging sign that more ACOs are preparing to take on risk, but it’s vital to recognize all the time and effort for these ACOs to be ready to assume risk. We need to continue to improve the ACO program as a whole to provide the stability and demonstrated success necessary for ACOs to feel confident to enter into these risk-based ACO models.”

There have several indicators that providers are moving towards risk-based payment models, if more slowly than envisioned. Sixty percent of American Medical Group Association (AMGA) members said in a Dec. 2017 survey they’ll be ready to take on downside risk within two years. Encouraging their efforts could be the promise of benefitting from two-sided risk when factoring in the 5 percent bonus payment available under AAPMs.

For wary providers, however, the decision can’t be put off for much longer.

“You can stick with the status quo and contribute to the financial failure of the communities you’re supposed to serve, or actively participate in the restructuring of American healthcare,” said Francois de Brantes, MS, MBA, vice president and director of the Altarum Institute’s Center for Payment Innovation, at the 2017 Healthcare Financial Management Association (HFMA).