In an open access commentary published today in the New England Journal of Medicine, Center for Medicare and Medicaid Services Administrator Donald Berwick explains the changes made in the final rule in the Medicare Shared Savings Accountable Care Organization Program, also finally published today.

Dr. Berwick explains some of the major changes made in the final rule: providing better, and more timely, information to ACOs at the outset of the performance year through preliminary prospective alignment of beneficiaries (while retaining a retrospective reconciliation to ensure that ACOs are measured on the basis of the patients they actually care for during the year); retaining a strong monitoring and quality measurement mechanism while streamlining the metrics to focus on what matters most, including reducing the total number of quality measures by about half; allowing start-up ACOs to choose a “savings only” track without financial risk during their initial contract period; sharing savings with successful ACOs on a “first dollar” basis when the ACO achieves meaningful savings for the Medicare program and im- proves care or provides high- quality care; and creating a pathway for full participation of federally qualified health centers and rural health clinics that provide a primary care safety net for Medicare beneficiaries in underserved areas.

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