CMS issued a press release titled, “Pioneer Accountable Care Organizations succeed in improving care, lowering costs.” CMS claims: “Today, the Centers for Medicare & Medicaid Services (CMS) announced positive and promising results from the first performance year of the Pioneer Accountable Care Organization (ACO) Model, including both higher quality care and lower Medicare expenditures.”
However, Ken Perez, Senior Vice President of Marketing and Director of Healthcare Policy at MedeAnalytics notes: “upon closer examination, the report card would appear to be rather checkered.” In fact, seven of the ACOs have opted to “step down to the less-risky Medicare Shared Savings Program (MSSP) and two have decided to no longer be a Medicare ACO, Pioneer or MSSP.”
Perez says this should not be a surprise. On February 25, 2013, 30 of the 32 Pioneers wrote to CMS and: “expressed concern about the program’s quality benchmarks and lack of data and requested reporting-based, as opposed to performance-based, payments for performance year 2013. All nine of the Pioneers that are either transitioning to the MSSP or are ceasing to be Medicare ACOs signed that letter.”
“These results are reminiscent of what happened with the Physician Group Practice (PGP) Demonstration Project, a precursor to the current Medicare ACO programs, in which only two of 10 participating ACOs succeeded in the first year. Encouragingly, the participants in the PGP Demonstration Project in general improved their performance during the following years, so one would expect the 23 Pioneers still in the program to show better results in the years ahead.”
Other doubts have been raised that ACOs will drive insufficient change in physician behavior and patient engagement, result in insufficient savings, create a specialist (and thus patient) backlash, suffer from lack of agreement over measures and metrics, and drive up prices due to consolidation.
Furthermore, while the president and his allies see ACOs as a way to improve care and reduce costs, it appears the ACO model is going to be more successful in the private sector. For example: “U.S. health insurer UnitedHealth Group Inc. (UNH) announced that it intends to expand its accountable care contracts to $50 billion over the coming five years.
UnitedHealth’s Accountable Care Organization (ACO) initiative will span its employer-sponsored, Medicare and Medicaid health benefit businesses.” And: “In the U.S., UnitedHealth is engaged in accountable care contracts with more than 575 hospitals, 1,100 medical groups and 75,000 doctors. UnitedHealth expects more care providers to move to accountable care contracts over the next five years.
Via ACO, UnitedHealth targets on getting timely information to the provider to improve care for patients and build healthier communities. These solutions also focus on growing membership in the company’s medical products through provider collaborations that are designed to lower costs.
UnitedHealth’s Accountable Care Solution (ACS) business offers a suite of solutions designed to facilitate delivery system reform and help reduce the cost of care by enabling population health management for providers.”
As we previously noted on Policy and Medicine: “ACO’s are being embraced by public and private sector payers. It is important that we don’t reject this model before it has just begun to gain traction. With additional education of providers, that promise of savings despite what the critics predict may well be achieved.”
We noted: “In just the area of Accountable Care Organizations (ACO’s), the government will require 64 quality measures for participating facilities. Commercially supported CME provides a unique media to train and educate America’s health care providers on strategies on how to implement and meet those measures.”