Dive Brief:
- A new report from Aledade, a company that helps physicians form and operate accountable care organizations (ACOs), says its groups have successfully increased primary care utilization and revenue, decreased lab and imaging costs, and decreased emergency department and hospital utilization and readmissions.
- The findings were shared to provide a "frontlines" perspective on the challenges and lessons learned in delivering value as a Medicare Shared Savings Program (MSSP) ACO.
- The report calls out "regulatory headwinds" that it says are currently working against ACOs in the program, including the national benchmark used to determine savings. Although the implementation of regional benchmarking will provide a more accurate measurement in years 4-9, in the meantime it still leaves some ACOs facing a longer stretch of time to achieve financial success.
Dive Insight:
ACOs have remained a source of some mystery and debate since the MSSP was first founded in 2010 to allow providers to get paid more by delivering improved outcomes at lower costs, as part of the effort to move toward value-based payment.
Recent CMS data indicated in 2015, ACOs saved a combined total of $466 million, though of the 392 MSSP participants, only 119--or less than a third--earned shared shavings. That aspect of the program is dependent upon whether participants have healthcare costs lower than their benchmark and meet the minimum savings.
One point the CMS and Aledade reports both stress is that more time in the program tends to result in more savings. CMS noted 42% of ACOs that entered the program in 2012 generated savings above their minimum savings rate, compared to just 21% of those who entered in 2015.
In order to help shed more light on how ACOs can be successful in delivering value, Aledade's report provides program observations and details the experiences of two of its ACOs that were part of the 2015 cohort.
Beyond benchmarking, the report notes challenges around hospital coding, risk adjustment and information flows/information blocking from EHR vendors and hospitals. Aledade's takeaways include the importance of scale, and the notion that MSSP policies can be improved to help shorten ACOs' timeline to financial success.
Further, Aledade founder Farzad Mostashari argues that while achieving savings takes time, "the benefits of the program to patients and taxpayers are not limited to those ACOs that received shared savings distributions."