New data released by the Centers for Medicare & Medicaid Services shows more evidence that accountable care organizations have reduced direct Medicare spending in 2016.
Participants in the Medicare Shared Savings Program (MSSP), the agency’s largest ACO program, saved a total of $652 million, according to data released on Friday by CMS. Like it did earlier this month with information about the Pioneer ACOs and Next Generation ACO model, the agency released the data with little fanfare and included the information in spreadsheets with no announcement.
In total, data from the MSSP, Pioneer ACOs, Next Generation and Comprehensive ESRD Care (CEC) Model reduced gross Medicare spending by $836 million in 2016, returning $70.6 million in net savings to the Medicare Trust Fund, according to an analysis of the information from the Health Care Transformation Task Force.
“These results demonstrate the promise of new models of care delivery and financing for improving patient outcomes and reducing spending,” David Lansky, chair of the Health Care Transformation Task Force, said in an announcement. "This provides further evidence that we need more, not less, public and private sector investigation of alternatives to traditional fee-for-service medicine."
Although CMS paid more in shared savings than it saw in net returns, the task force said 56% of MSSP participants reduced their expenditures and 31% reduced costs enough to earn shared savings. The CEC model also showed promising results. All 13 participants produced a total of $75 million in savings, according to the task force. The net savings to CMS was $23.9 million, as all but one of the 13 CEC participants earned shared savings.
Total savings are calculated by CMS based on what Medicare would have expected to spend on the beneficiaries covered by the ACO in traditional fee-for-service Medicare. Net savings reflect the total minus shared savings payments to the ACOs for meeting spending targets, and accounting for repayments from ACOs for shared losses.
'True leaders in healthcare'
Joe Damore, vice president of population health management of Premier, an alliance of approximately 3,900 U.S. hospitals and health systems, said the organization applauds the 432 MSSP ACOs, as well as the Next Generation and Pioneer ACOs for their efforts.
“These are true leaders in healthcare that are succeeding in implementing value-based, wellness-focused care delivery models," he said in a statement.
Damore noted that members of Premier’s Population Health Management Collaborative make up 6% of all Medicare ACO participants in 2016 yet generated 11% of the savings to Medicare across the MSSP Pioneer and Next Generation ACO programs. Nearly 75% of Premier ACO collaborative members achieved savings to Medicare, compared to 57% achieving savings across all Medicare ACO programs. He also said that 46% of Premier collaborative members were able to share in savings compared to 33% of all Medicare ACOs nationwide.
Performance improvement over the long haul
The performance results show that on average, ACOs improve on both savings and quality the longer they participate in the program, according to Barbara Walters, executive vice president and chief Population health officer of Trinity Health, one of the task force members.
Three of the task force members that had ACOs earning substantial savings included:
Cleveland Clinic ACO saved $42.2 million in savings in 2016, a 24.5% increase from 2015. The ACO will receive $19.9 million back in shared savings, a 19.8% increase over 2015. The number of shared beneficiaries increased by more than 6,500 and the health system’s quality score was 96.3%.
Aledade, Inc., which partners with primary care physicians to operate ACOs across 15 states and in partnership with more than 240,000 patients in more than 200 practices, saved Medicare more than $9.3 million. In the 2016 performance period, Aledade had 142 practices with more than 80,000 patients in 11 states.
Arizona Care Network, a physician-led Track 1 ACO co-administered by Task Force member Dignity Health, received an 89.9% score for quality of patient care and reduced the cost of Medicare spending by more than $5.78 million.
In addition, the task force said the following members lowered Medicare costs:
- Ascension’s MissionPoint Health Partners cut costs by $1.64 million; MissionPoint Evansville, LLC: $3.26 million.
- Greenville Health System’s MyHealth First Network, LLC cut costs by $21.7 million.
- Trinity Health’s Trinity Health Michigan d/b/a St. Mary Mercy Hospital lowered Medicare costs by $11.4 million.
- Fresenius Medical Care lowered Medicare expenditures by $43.3 million and earned $29.7 million in shared savings across six ACOs participating in the Comprehensive ESRD program:
- Fresenius Seamless Care of Philadelphia: $6.9 million
- Fresenius Seamless Care of San Diego: $10.3 million
- Fresenius Seamless Care of Chicago: $11.2 million
- Fresenius Seamless Care of Columbia: $4.4 million
- Fresenius Seamless Care of Dallas: $8.2 million
- Fresenius Seamless Care of Charlotte: $2.4 million