Dive Brief:
- CMS has issued quality and financial performance results suggesting that Medicare accountable care organizations have boosted the quality of care for Medicare beneficiaries by improving collaboration and keeping the patients healthy.
- Not only did ACOs in the Pioneer ACO and Medicare Shared Savings program generate more than $372 million in total program savings for Medicare ACOs, the provider ACOs also qualified for shared savings payments of $445 million. This data comes from the second year of performance for 23 Pioneer ACOs and the first year of performance for 220 Shared Savings Program ACOs.
- Since the passage of the ACA, more than 360 Medicare ACOs have been formed, serving more than 5.6 million Americans with Medicare.
Dive Insight:
While CMS is understandably trying to put a good spin on things, it seems that the Medicare ACO program is in trouble. Most notably, the Pioneer ACO program isn't paying off for providers, 10 of which have exited since the program began. The providers in the Pioneer program, chosen because of their relative maturity and presumed ability to handle risk, have not benefited from the program in the way they'd hoped.
For example, as Healthcare Dive noted a couple of weeks ago, San Diego's Sharp HealthCare recently dropped out of the Pioneer program. In its third-quarter financial report Sharp leaders noted that they were at risk for making a big payment to Medicare, despite the fact that they had cut readmission rates. Sharp execs said the deal wasn't working out because CMS was setting standards on a national level. rather than adapting to the markets in which it operated.
There's the germ of a good idea in the Pioneer ACO and Shared Savings programs, which theoretically offer providers the chance to get paid bonuses for what they do best. But as things stand, if even a high performer like Sharp risks having to pay millions back to Medicare, there's something seriously wrong here.
Still, things may change soon. In July, CMS announced some possible changes to ACO quality reporting. The agency is expected to release new proposed rules soon.
Want to read more? You may enjoy this story about how one insurer exposed Medicare ACOs' biggest flaw.