Medicare ACOs growing faster than non-Medicare ACOs

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Medicare accountable care organizations outnumber non-Medicare ACO contracts and make up more than half of the 488 ACOs nationwide, according to an August 2013 update from Leavitt Partners, a healthcare consultancy that follows ACO development.

The report, Growth and Dispersion of Accountable Care Organizations: August 2013 Update, reveals three significant findings:

  1. The number of accountable care entities is increasing. Since the healthcare reform law passed three years ago, 488 ACOs have formed--and more than doubled since June 2012.
  2. Medicare ACOs are growing faster than non-Medicare ACOs and make up more than half of all accountable care contracts nationwide.
  3. No single model has emerged as most successful and as accountable care expands, the agency expects to continue to see variety in models and execution.

These ACOs are transforming the way healthcare is delivered but many of the estimated 27 million people in ACOs aren't even aware they are in one, according to U.S. News & World Report. However, they do notice their physicians and other care providers are more attentive to their needs, the article stated, a result of the Affordable Care Act, which is forcing healthcare professionals to provide more coordinated, high-quality care at lower costs.

U.S. News points to 73-year-old James Conway, a Medicare beneficiary, as an example of how an ACO improved patient care. The Massachusetts resident suffers from high blood pressure, needs a catheter that has led to several urinary tract infections and a condition that causes spinal fluid to build up in the base of his skull. He has been to the hospital four times in the last year. But recently he noticed an improvement in his care.

Since the spring, pharmacists have visited Conway at home to examine his medicines, cut out five of the drugs from his 18-drug regimen, explained the purpose of each drug, and created a spreadsheet to remind him when to take the medication, the article said. In addition, the pharmacists check in with him weekly as does a nurse who helps organize his care and arranged for an aide to change his catheter on a regular basis.

The change in his care occurred when Conway's primary care physician decided to take part in a Pioneer ACO sponsored by Boston-based Steward Health Care System, an integrated delivery network of 11 hospitals and 2,900 doctors. The Pioneer ACO arrangement calls for Medicare to pay Steward hospitals and doctors based on their successful treatment of 47,000 beneficiaries within the ACO, with a goal of keeping them out of the hospital.

 "ACOs are very interested in reducing acute care, episodic hospitalizations," Andrew Croshaw, managing director of Leavitt Partners, told U.S. News. "It is one of the key ways to have an ACO succeed financially."

Dominique Morgan-Solomon, director of care management at Steward, told U.S. News that reducing hospitalizations and readmissions is one of the system's top priorities. "Our objective is meeting the patients' needs and providing care wrapped around patients," she said, adding that often it's less expensive and better to provide that care at a patient's home.

To learn more:
- here's the Leavitt Partner's announcement
- check out the report (.pdf)
- read the U.S. News article

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