Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Risk Management News

CMS Reports ACOs Assume High Risk Yet Generate High Savings

"Today’s announcement is part of a broader effort to seize on this historic moment and transform our health care system into one that works better for the American people."

- Accountable care organizations (ACOs) generated over $411 million in net program savings last year, according to financial and quality performance results from the Centers for Medicare & Medicaid Services (CMS).

Pioneer ACO Model Medicare Shared Savings Program

“The Affordable Care Act takes important steps toward a more accessible, affordable, and higher-quality health care system,” says CMS within a press release. “Today’s announcement is part of a broader effort to seize on this historic moment and transform our health care system into one that works better for the American people,” the organization adds. 

Twenty ACOs in the Pioneer ACO Model and 333 in the Medicare Shared Savings Program – 119 of which are in the midst of their Track 1 performance year – generated this sizable amount in total savings last year, says CMS. This amount includes all savings and losses.

According to CMS, these Pioneer ACOs tend to be more experienced, having adapted coordinated care initiatives relatively early on. Resultantly, they are able to assume larger performance-based financial risk levels, CMS adds.

Concurrently, 97 ACOs qualified for shared savings payments topping $422 million, says CMS. These 97 ACOs met both quality standards and their savings threshold.

Such results imply ACOs are consistently delivering high quality care, says CMS, even as they continue to serve even more Medicare beneficiaries annually. According to CMS’s early indications, the number of Medicare beneficiaries served by ACOs will likely grow once again next year.

“ACOs are judged on their performance on an array of meaningful metrics that assess the care they provide – including how highly patients rated their doctor, how well clinicians communicated, whether they screened for high blood pressure and tobacco use and cessation, and their use of Electronic Health Records,” CMS maintains. 

“In the third performance year, Pioneer ACOs showed improvements in 28 of 33 quality measures and experienced average improvements of 3.6% across all quality measures. Shared Savings Program ACOs that reported quality measures in 2013 and 2014 improved on 27 of 33 quality measures.”

The results additionally demonstrate more experienced ACOs generally perform better with time. ACOs are collectively transforming how care is being provided, says Andy Slavitt, CMS Acting Administrator, in a press release. “Many of these ACOs are demonstrating that they can deliver a higher level of coordinated care that leads to healthier people and smarter spending,” Slavitt states.

Such findings have not always been the case. As EHRIntelligence.com reported in 2013, some Pioneer ACOs failing to produce savings left for good with intentions to apply to the Medicare Shared Savings program. Such occurred even before the Pioneer ACO program had reached its third year of implementation.

As RevCycleIntelligence.com reported, over the last two years alone, Pioneer ACOs have generated over $380 million in Medicare savings.

Medicare beneficiaries in Pioneer ACOs report high quality, coordinated care – more appropriate levels of care delivered, stronger communication levels among healthcare providers, fewer numbers of tests and procedures performed, and more post-hospital discharge provider follow-up visits.

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