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CMS: 'Healthier People, Smarter Spending' With ACOs

By Shannon Firth, MedPage Today  
   August 28, 2015

Medicare Accountable Care Organizations continue to improve care quality and to lower costs, according to a report from the Centers for Medicare & Medicaid Services. From MedPage Today.

This article originally appeared in MedPage Today.

Medicare Accountable Care Organizations (ACOs) continue to improve care quality and to lower costs, according to a new report from the Centers for Medicare & Medicaid Services (CMS).

"Many of these ACOs are demonstrating that they can deliver a higher level of coordinated care that leads to healthier people and smarter spending," said CMS Acting Administrator Andy Slavitt, MBA, in a press release that accompanied the detailed report on ACO performance in 2014.

Medicare ACOs comprise hospitals, physicians groups, and other clinicians working in collaboration to coordinate care for all patients. Since the Affordable Care Act was passed, 420 Medicare ACOs have been established, caring for around 7.8 million people in the U.S., according to CMS.

Pioneer ACOs, "the early adopters of coordinated care," met their targets for 28 of 33 quality benchmarks -- a 3.6% improvement, according to the agency. Shared Saving programs, which are a risk-averse model in comparison with Pioneer, achieved 27 of 33 quality measures in 2013 and 2014, the release stated.

In 2014, 20 Pioneer ACOs and 333 Shared Savings Program ACOs produced an estimated $411 million in savings, "which includes all ACOs savings and losses," the agency reported.

The report also noted that "97 ACOs qualified for shared savings payments of more than $422 million by meeting quality standards and their savings threshold."

Among the Pioneer ACOs, the report found "strong improvement" on three significant measures from 2013 to 2014:

  • "Medication reconciliation" grew from 70% to 84%
  • "Screening for clinical depression and follow-up plan" jumped from 50% to 60%
  • "Qualification for an electronic health record incentive payment" increased from 77% to 86%

Elliot Fisher, MD, MPH, director of the Dartmouth Institute for Heath policy and Clinical Practice in Hanover, N.H., told MedPage Today that he was struck by the fact that the longer a hospital or physician group had been participating in the program, the more likely they were to achieve savings.

More than one-third of the 333 Shared Savings programs are in their first year, according to CMS.

"These results are very consistent with prior years and support the conclusion that the model is changing behavior; it's working [and] it achieved some savings for the country and some savings for health systems," Fisher said.

Asked about the significance of the 89 Shared Savings Programs that lowered healthcare costs but did not achieve shared savings, Fisher said he expects those groups won't quit their programs. He anticipates they will have a better chance of succeeding under a new set of rules, expected to be released this fall, that alter thresholds for meeting targets.

Fisher -- who is a member of the Health Care Transformation Task Force, a private sector group focused on accelerating the movement towards value-based models -- said one of the challenges for hospitals and physician groups is that many other payers are still operating in a fee-for-service model.

One way to improve the ACO model is to encourage more commercial payers to shift towards value-based models. A second strategy to enhance this care model is to track regional and national cost trends and tweak benchmarks to account for demographic factors, he said.

Relaxing certain quality metrics so that a greater number of ACOs have a chance to capture early savings would encourage those new to the program to continue their efforts. Lastly, Fisher said the leaders of healthcare organizations need to "get serious" about value-based care. A culture change is critical "because the country needs it," he added.

Daniel Derksen, MD, director of the Center for Rural Health at the University of Arizona's Mel & Enid Zuckerman College of Public Health in Tucson said what impressed him most about the latest ACO performance results was that both types of ACO models improved on 80% of the quality measures.

As far as fiscal performance, he also noted, that "those who have been at it a little longer do better." Around one in four ACOs earned bonuses for meeting cost benchmarks, a figure Derksen said he viewed as "promising."

Emily Brower, MBA, is vice-president of population health at Atrius Health, a health system that received the highest score in the Pioneer ACO category in New England. By saving Medicare $4.5 million, Atrius earned $2.8 million back in savings.

2014 was a great year for us," she said, but meeting targets for new quality measures was not easy, she added.

It helped when clinicians understood that the metrics actually mattered, she explained. For example, screening for fall prevention leads to interventions, such as referring a patient to physical therapy or reviewing his or her medications and their side effects.

"We're not going to chase measures on quality reporting if they're not clinically meaningful," she said.

"You can never take your eye off the ball," she added.

Speaking more broadly of other Pioneer ACO and Shared Savings programs, Brower said that even those that did not achieve the necessary savings to earn back their investments still made important changes in care delivery that will better position them to meet those goals in the future.

"I think it's a really positive story for a more sustainable healthcare delivery and payment model, which we need. We need it for our communities, we need it for our patients, [and] we need it for our employers," she said.

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