Medical adviser shares secrets of ACO success

Advance Payment Model accountable care organizations (ACOs) have improved care quality and generated significant savings by analyzing high-risk patients, according to Becker's Hospital Review.

ACOs operating under the Advanced Payment model are usually physician-led organizations formed in smaller, rural areas. The Centers for Medicare & Medicaid Services (CMS) provides them with both flat and variable funds with the goal of driving up participation, improving care and creating savings. To share in savings, they must reimburse CMS for the advance payments. If they do not generate sufficient savings in their first year, CMS offsets shared savings over the next few years.

Integrated ACO, one of four such ACOs in Texas, reported savings of more than $3.5 million its first year, one of six Advanced Payment Models nationwide to share in savings out of 36 total. Part of the reason for the ACO's success is its use of patient data to identify the most common ailments and highest-cost patients, Vipul Mankad, M.D., who serves as senior medical adviser to Integrated's board, told Becker's.

"In descriptive statistics, you would know which patients were admitted in the last year for various problems; you know 5 or 10 percent generate 50 percent of the cost," Mankad said. "But if you simply generate a list of high-cost patients from last year, it might not be the same group next year. That's because you've already worked on their problems and a problem in the past doesn't necessarily repeat in the next year."

Integrated's good news comes at an uncertain time for ACOs. Although Medicare ACOs improved in both quality and savings their second year, three Pioneer ACOs left the program in September, citing regulations imposed after they failed to meet their performance goals. And a proposed CMS rule that would give ACOs in the Medicare Shared Savings Program more time before they face penalties for poor performance doesn't go far enough to stop those ACOs from dropping out of the program,  FierceHealthcare reported yesterday.

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