2025 SOA Health Meeting Virtual Event: Session 7A: What Happens When ACOs Get SAHS-sy? -07.24.25- Recording

In this session, we will address a new component of the financial reconciliation process for the Medicare Shared Savings Program that was introduced in the fall of 2024, which removes accountable care organization (ACO) liability for Significant, Anomalous, and Highly Suspect (SAHS) spending for Medicare beneficiaries.
Attendees will learn how this was implemented for the 2023 performance year, and how Centers for Medicaid and Medicare Services (CMS) will address similar issues going forward per the 2025 Medicare physician fee schedule. The session will include a case study of an ACO dealing with this uncontrolled spend and how they are managing through it and a discussion on how ACOs can monitor for new anomalous spending.