Medicare ACOs show progress despite exits

The struggles Medicare Accountable Care Organizations face have made headlines of late, but a deeper look at the data shows some progress.

Recent data from the Centers for Medicare & Medicaid Services on the Pioneer ACO program’s fourth year found quality increased on average throughout the program, according to the analysis published on the Health Affairs Blog. Between 2014 and 2015, average Pioneer ACO quality scores rose just about 5 percentage points, and in 2015 nine of the program’s 12 ACOs achieved quality scores over 90 percent.

In 2015, six of the Pioneer ACOs that are still in the program as of this year achieved shared savings. “With the Pioneer Program ending, these organizations could be motivated to transition into the Next Generation ACO model in 2017,” the Health Affairs authors state, “but that will depend in large part on individual Pioneer assessments about the adequacy of rewards for quality and cost improvement" and sufficient regulatory flexibility to allow these organizations to make changes to payments and practice protocols.

News was mixed-to-positive for the Medicare Shared Savings Program (MSSP) as well. In 2015, MSSP ACOs generated $429 million in total savings, shared by 119 of the ACOs. Eighty-three ACOs within the program cut costs, but not to the degree that they shared in savings. Another 189 exceeded their spending benchmarks but weren’t responsible for repaying the losses to CMS.

For ACOs eligible for shared savings, payments ranged from $855,000 to $41.9 million. The average payment was $5.4 million, a $1.4 million increase from 2014. Ten of the MSSP participants exceeded $10 million in their shared savings.

The authors also analyzed the top and bottom 20 performers in the program over a three-year period, and found four of the bottom 20 in year one were able to achieve savings by the third year, with three earning shared savings--though two of the top 20 in year one suffered losses by the third year.

The charts below show the changes in savings among the top and bottom performers:  

Exhibits reprinted with permission from Health Affairs.