Government report says ACOs in MSSP 'show promise'
- An analysis of the first three years of the Medicare Shared Savings Program (MSSP) shows that most participating accountable care organizations (ACO) reduced spending and improved care quality in that time, according to a report from the HHS Office of Inspector General (OIG).
- The ACOs reduced spending by a total of $3.4 billion in the three years studied for a net reduction of nearly $1 billion, but some of them contributed far more to that figure than others. About half of the reduction was generated by just 36 ACOs out of the total 428, and three in that group were responsible for a quarter of that amount.
- A small subset of the participating ACOs had substantially reduced spending without sacrificing quality. That group reduced spending by an average of $673 per beneficiary, partly through increasing primary care services and reducing emergency department visits.
ACOs are some of the most prevalent alternative payment models and their relatively low risk for providers make them an attractive entry point for those who want to move further into the value-based care payment landscape.
While the industry is still grappling with how to evaluate value-based care models, several analyses have shown ACOs’ potential to achieve healthcare’s triple aim. More and more organizations are giving it a try and continued positive results are likely to see the trend grow.
The OIG report shows ACOs can work, but some of them work a lot better than others. It also shows — not for the first time — that ACOs often improve as they become more established over time. Further study is needed to show what the high-performing ACOs do better and what they change to improve from year to year.
ACOs that were in the MSSP program for three years reducing spending by an average of about $10 million in 2015, while ACOs that had been in the program for just one year saved about $5.4 million. Two-thirds of the ACOs reduced spending for at least one of the years they participated in the program.
The OIG did find that the high-performing ACOs studied tended to have more and sicker beneficiaries and were more likely to include only physicians. The agency said it is conducting further evaluation of the best-performing groups.
The ACOs, on average, also had better quality scores than fee-for-service providers in more than 80% of 33 individual measures. The average overall quality score, which ranges from 1 to 100, increased from 86 in 2014 to 91 in 2015.
The ACOs also grew more diverse as the program went on. In 2013, 42% of the ACOs were made up of only physicians. That decreased to 34% in 2015. Of all the ACOs that included more than just physicians in 2015, two-thirds included hospitals. Home health agencies were included in 39% of participating ACOs, nursing homes in 33% and hospices in 32%.
The report found the ACOs' most improved quality measures were mostly low-hanging fruit like delivering the flu vaccine and screenings for depression, fall risk and body mass index. The results demonstrate how ACOs can improve care through better patient engagement and keep small, but still important, issues from slipping through the cracks.
“With any major payment reform, time may be needed for organizations to make changes to improve quality and lower costs," the report concluded. "While policy changes may be warranted, ACOs show promise in reducing spending and improving quality.”
- HHS Office of Inspector General MEDICARE PROGRAM SHARED SAVINGS ACCOUNTABLE CARE ORGANIZATIONS HAVE SHOWN POTENTIAL FOR REDUCING SPENDING AND IMPROVING QUALITY
- Healthcare Dive ACO participation likely to lead to positive payment adjustments under MACRA
- Healthcare Dive Is value-based care making a difference?
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