How NYC Health + Hospitals found ACO success, reducing Medicare costs and earning millions in savings

Although experts are often divided on the effectiveness of accountable care organizations, the experience of one Medicare ACO shows that the model can be adapted to meet the needs of safety-net providers and their unique patient populations. 

ACOs have had mixed success over the years, but recent data from the Centers for Medicare & Medicaid Services shows that providers that stuck with the model have seen the efforts bear fruit; Pioneer and Next Generation ACOs, for example, generated millions in savings last year.

And one ACO that was established in 2012 to participate in the Medicare Shared Savings Program has also had success, according to a blog post for Health Affairs. Indeed, the authors write, NYC Health + Hospitals' ACO has reduced costs to Medicare by more than $31 million and generated $14 million in shared savings payments. The organization has reduced costs by between 4% and 12% each year compared to benchmarks, and it is the only ACO in New York to earn shared savings each year in MSSP.

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NYC Health + Hospitals has learned value-based and accountable care lessons as it built its Medicare ACO, according to the article. First, it gathered ACO claims data to track the needs and challenges of its 12,000 Medicare patients, many of whom are dual-eligible, and then used that information to chart a future course of care.

For example, the data suggested that the organization would do well to focus on the chronically ill and costs for their complex care, and less on overutilization of healthcare services.

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With the data and a framework in place, the organization then engaged frontline clinicians on the initiative, fostering leadership in the ACO. It allowed clinicians the autonomy to shape the program to fit patient needs within a shared set of goals, according to the blog post.

The model has been so successful, the authors write, that the organization is now applying the lessons learned to other populations in the hospital system, particularly Medicaid and uninsured patients.