Starting with Performance Year (PY) 2025, every Shared Savings Program ACO must report the APP Plus quality‑measure set (four clinical quality measures + the CAHPS survey + the claims‑based readmission measure). Your ability to share in savings—or avoid losses—hinges on these possible pathways:
| 2025 Quality Performance Standards Summary | ||
|---|---|---|
| Pathway | What you must clear | What you earn |
| Standard Quality Performance Standard (All ACOs) | Achieve a health equity adjusted quality performance score ≥ 76.70 (40th percentile MIPS Quality performance category score, excluding facility-based entities) | Maximum shared-savings rate and reduced downside risk |
| Standard Quality Performance Standard (For ACOs reporting all 4 eCQMs/MIPS CQMs with completeness) | • Achieve a quality score ≥ 10th percentile on ≥ 1 of the 3 outcome measures • AND a score ≥ 40th percentile on ≥ 1 of the 5 remaining APP Plus measures | Maximum shared-savings rate and reduced downside risk |
| Standard Quality Performance Standard (First year ACOs) | Meet MIPS data completeness on 4 APP Plus CQMs + receive a MIPS Quality score + administer the CAHPS for MIPS Survey | Maximum shared-savings rate and reduced downside risk |
| Alternative Quality Performance Standard (All ACOs) | Achieve a quality score ≥ 10th percentile on ≥ 1 of the 3 outcome measures (reporting via APP using any combination of eCQM/MIPS CQM/Medicare CQM) | Shared savings at a reduced rate scaled by health equity adjusted score; scaled shared losses for ENHANCED ACOs |
Everything below spells out what the Standard Quality Performance Standard means—measure by measure—for eCQMs, MIPS CQMs, and Medicare CQMs.
1 · eCQMs (all‑payer)
1.1 Standard Quality Performance Standard (40th percentile)
Target: Average ≥ 7.67 points per measure (Decile 7) to reach the composite 76.70 once CAHPS and Hospital-Wide All-Cause Unplanned Readmission Measure (HWR) are factored in.
| 2025 Thresholds to Earn 7.67 Points by Measure | |||
|---|---|---|---|
| Quality ID | Measure | Inverse? | Performance Rate to earn 7.67 pts |
| 001 | HbA1c Poor Control > 9 % | Yes | ≤ 24.51% poor control |
| 112 | Breast‑Cancer Screening | No | ≥ 71.67 % screening |
| 134 | Depression Screening & Plan | No | ≥ 67.01% screening |
| 236 | Controlling High Blood Pressure | No | ≥ 74.20% BP control |
| 321 | CAHPS for MIPS | n/a | 2025 deciles released post‑performance year |
| 479 | 30‑Day All‑Cause Readmission | n/a | 2025 deciles released post‑performance year |
Action: Run quarterly test submissions out of your EHR and watch the decile scores; adjust workflows until each measure sits in Decile 7 or higher.
Benchmarks for eCQMs are historical and usually shift only 1‑2 percentage points year‑to‑year.
1.2 Standard Quality Performance Standard (10th/40th percentiles)
Official 2025 eCQM benchmarks identify the exact cut‑points you must hit on at least two measures—a qualifying outcome (≥10th pct) and any other measure (≥40th pct):
| 2025 Quality Measure Cut-Points and Scoring | ||||
|---|---|---|---|---|
| Quality ID | Measure | Inverse? | 2025 cut‑point you must hit | Points earned |
| 001 | Diabetes: HbA1c Poor Control > 9 % | Yes | ≤ 94.35 % poor‑control rate (10th pct) | 2 pts |
| 236 | Controlling High Blood Pressure | No | ≥ 65.32 % BP‑control rate (40th pct) | 5 pts |
TIP: By meeting just two targets — a performance rate of ≤ 94.35% on A1c poor control and ≥ 65.32% on BP control — and ensuring data completeness across all four eCQMs, the ACO can qualify for the maximum shared savings rate.
2 · MIPS CQMs (all-payer)
2.1 Standard Quality Performance Standard (40th percentile)
Same math as eCQMs: shoot for ≥7.67 points per measure.
| 2025 Thresholds to Earn 7.67 Points by Measure | |||
|---|---|---|---|
| Quality ID | Measure | Inverse? | Performance Rate to earn 7.67 pts |
| 001 | HbA1c Poor Control > 9 % | Yes | ≤ 33.93% poor control |
| 112 | Breast‑Cancer Screening | No | ≥ 85.76 % screening |
| 134 | Depression Screening & Plan | No | 100% screening |
| 236 | Controlling High Blood Pressure | No | ≥ 66.7% BP control |
| 321 | CAHPS for MIPS | n/a | 2025 deciles released post‑performance year |
| 479 | 30‑Day All‑Cause Readmission | n/a | 2025 deciles released post‑performance year |
2.2 Standard Quality Performance Standard (10th/40th percentiles)
Official 2025 MIPS CQM benchmarks identify the exact cut‑points you must hit on at least two measures—a qualifying outcome (≥10th pct) and any other measure (≥40th pct):
| Practical 2025 Quality Targets and Rule Alignment | |||||
|---|---|---|---|---|---|
| Quality ID | Measure | Inverse? | Practical 2025 target | Points | Which rule it satisfies |
| 001 | HbA1c Poor Control > 9 % | Yes | ≤ 90 % poor‑control rate | 2 pts | ≥10th‑pct outcome |
| 236 | Controlling High Blood Pressure | No | ≥ 40 % BP‑control rate | 5 pts | ≥40th‑pct other |
TIP: Achieving just these two targets — a performance rate of ≤ 90% on A1c poor control and ≥ 40% on BP control — while meeting data completeness on all four MIPS CQMs, enables the ACO to earn the maximum shared savings rate
3 · Medicare CQMs
Medicare CQMs are scored with flat (static) benchmarks for 2025. The goal under the standard pathway is to keep each measure at ≥7.61 points.
| 2025 Thresholds to Earn 7.67 Points by Measure | |||
|---|---|---|---|
| Quality ID | Measure | Inverse? | Performance Rate to earn 7.67 pts |
| 001SSP | HbA1c Poor Control > 9 % | Yes | ≤ 33.93% poor control |
| 112SSP | Breast‑Cancer Screening | No | ≥ 66.7 % screening |
| 134SSP | Depression Screening & Plan | No | ≥ 66.7% screening |
| 236SSP | Controlling High Blood Pressure | No | ≥ 66.7% BP control |
| 321 | CAHPS for MIPS | n/a | 2025 deciles released post‑performance year |
| 479 | 30‑Day All‑Cause Readmission | n/a | 2025 deciles released post‑performance year |
Operational checklist
Mid‑year mock submission – Verify decile scores in your EHR/registry.
Focus resources – If the 76.70 bar looks out of reach, make sure at least one outcome measure sits at the 10th‑percentile and one other measure at the 40th‑percentile.
Watch inverse logic – Lower is better on QID 001; double‑check that dashboards are interpreting it correctly.
Leverage health‑equity adjustment – A small boost here can put an otherwise‑borderline score over 76.70.
Document everything – Numerator/denominator logic, exclusion handling, and data‑validation dates.
Key take‑aways
76.70 is the magic number for full savings.
An outcome measure in Decile 2 plus any other measure in Decile 5 passes the alternative pathway with eCQMs and MIPS CQMs
For Medicare CQMs, the mid‑60 % range (or ≤34 % for inverse) will keep you in the safety zone.
Nail these numbers early; the rest of APP Plus becomes a formality.
References
CMS, Performance‑Year 2025 40th‑Percentile MIPS Quality Performance Category Score Fact Sheet (Dec 2024)
CMS, Performance‑Year 2025 MIPS Quality Measure Benchmarks (Mar 2025)
MDinteractive, Medicare Shared Savings Program 2025 Reporting Requirements – CMS Final Rule (Nov 2024)
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