Pioneer ACO spending growth lower than other Medicare beneficiaries'

Accountable care organizations (ACOs) aligned with Medicare's Pioneer ACO program saw smaller increases in Medicare spending compared to general Medicare fee-for-service beneficiaries in the Pioneer program's second year, according to a study published in the Journal of the American Medical Association.

Researchers, led by Rahul Rajkumar, M.D., of the Centers for Medicare & Medicaid Services, analyzed spending and utilization in Medicare fee-for-service beneficiaries aligned with 32 Pioneer ACOs, compared with a control group of alignment-eligible beneficiaries. They found a difference of about $35.62 a month per beneficiary in 2012 and $11.18 a month per beneficiary in 2013 between Pioneer-aligned ACOs and the control group.

Lower inpatient utilization among ACO-aligned beneficiaries largely drove the lower spending increase. Steeper drops in primary care evaluation and management office visits and smaller increases in procedures, tests and images also were factors. Follow-up visits increased more for ACO-aligned beneficiaries, but Rajkumar and his team found no difference in 30-day readmissions.

ACO-aligned beneficiaries also had higher scores for clinician communication and timely care, according to the study.

"These results are encouraging, given how historically challenging it has been for physicians to achieve spending reductions in Medicare demonstration projects," Rajkumar and his team wrote. "Despite decreases in spending growth, results from this study and previously reported data on Pioneer ACOs' performance on clinical quality measures suggest it is possible to reduce expenditure growth while maintaining or improving quality in a FFS payment environment."

The next five years, however, will be the Pioneer ACO model's true test as far as cost control and care quality, Lawrence P. Casalino, M.D., Ph.D., of Weill Cornell Medical College, Healthcare Policy and Research, New York, wrote in an accompanying editorial.

Casalino noted that despite the smaller increases, Pioneer savings in the program's second year were one-third the savings of its first year. This could indicate cost-control methods were easier and more obvious in the first year, similar to how savings were higher in the Pioneer program for ACOs that were spending more to begin with. Alternately, he wrote, it may take longer to develop processes that improve care and lower costs in the long-term.

A report last September indicated Pioneer ACOs improved both quality and savings in the program's second year.

To learn more:
- here's the study
- read the editorial