Advanced Primary Care Called Key to ACO Success

Researchers find synergies that help accountable care organizations with advanced primary care physicians succeed financially and deliver high-quality care.

Advanced primary care boosts the savings rate and quality performance of accountable care organizations, research released this week says.

Researchers found a symbiotic relationship between ACOs and advanced primary care models such as patient-centered medical homes, the report says.

"Systems that already provided advanced primary care had a strong foundation on which to build an ACO, while becoming an ACO helped advanced primary care systems succeed by encouraging structural changes that align well with the PCMH model."

The research, which was conducted by the Patient-Centered Primary Care Collaborative and the Robert Graham Center, is based on a quantitative analysis of 333 ACOs and reviews of academic literature.

ACOs and advanced primary care share several keys to success, the researchers wrote.

"Many successful ACOs rely on good care coordination using care managers; robust and timely electronic health record information; increased access to care through means such as patient web portals and expanded office hours; and a focus on safety and quality improvement."

Two primary findings of the report are that ACOs with advanced primary care physicians have an increased likelihood of financial and quality of care success.

1. Shared savings gains
 

In their quantitative analysis, the researchers focused on 333 ACOs that participated in the Medicare Shared Savings Program in 2014. MSSP success was measured by shared savings earned and quality measure performance.

In MSSP, an ACO is given a total-cost-of-care spending benchmark based on historical performance. The ACO can earn shared savings payments if care expenditures are below the spending benchmark.

To assess the impact of advanced primary care on ACOs in MSSP, the researchers segmented the ACOs into quartiles, with the lowest quartile having no PCMH physicians and the highest quartile having 42.6% of physicians in PCMHs.

The researchers found that ACOs with PCMH physicians had modest but significantly higher shared savings compared to ACOs with no PCMH physicians.

"The savings rates of ACOs in the second highest and the highest quartiles for PCMH PCP share were on average 1.3 and 1.2 percentage points, respectively, higher relative to those in the lowest quartile group. The magnitudes of the estimates were non-trivial given that the mean savings rate was 0.6% for the study sample," the researchers wrote.

2. Quality boost
 

In 2014, MSSP had 33 quality measures. PCMH primary care physicians improve ACO quality performance, the report says.

"ACOs with a higher PCMH PCP share demonstrated higher quality as well, specifically in health promotion scores, health status scores, preventive service scores and chronic disease management scores."

Specific areas of higher quality performance included diabetic and coronary artery disease composite measures, pneumococcal vaccination, depression assessments, and tobacco screening.