ACOs Qualify for $422M in Savings Payments

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By Michael D. Williamson

Aug. 25 — Eligible providers participating in two types of accountable care programs qualified for $422 million in shared-savings payments from the Medicare program in 2014, according to the CMS.

The Centers for Medicare & Medicaid Services Aug. 25 issued the 2014 quality and financial performance results for the 20 participants in the Pioneer ACO program and the 333 Medicare Shared Savings Program (MSSP) ACOs. The agency said these ACOs generated more than $411 million in total savings in 2014, which includes all ACOs’ savings and losses.

An ACO is a group of doctors, hospitals and other health-care providers who work together to provide better, more coordinated care. The CMS said in a fact sheet that, as “the number of Medicare beneficiaries served by ACOs continues to grow, these results suggest that ACOs are delivering higher quality care to more and more Medicare beneficiaries each year.”

Pioneer Results 

The CMS fact sheet on the results said 97 Pioneer and MSSP ACOs qualified for the $422 million in payments from the CMS for meeting quality standards and their savings threshold.

Of the 15 Pioneer ACOs that generated savings, 11 generated savings outside a minimum savings rate and earned shared savings, the fact sheet said. These 11 ACOs qualified for shared savings payments of $82 million, according to the fact sheet.

Total savings generated through the Pioneer program were $120 million in 2014, the fact sheet said. The 2014 figure is an increase of 24 percent from 2013, when Pioneers saved Medicare $96 million, the fact sheet said. It also noted that in 2012, the first year the Pioneer program started, participating providers saved Medicare $88 million.

The Pioneer ACO Model is designed for health-care organizations and providers that are already experienced in coordinating care for patients across care settings.

Some Pioneer ACOs are actually paying the CMS, according to the announcement. The CMS said of the five Pioneer ACOs that generated losses, three generated losses outside a minimum loss rate and owed shared losses. “These ACOs are paying CMS $9 million in shared losses,” the fact sheet said.

MSSP Results 

As for the MSSP ACOs, the CMS paid qualifying providers $341 million for their share of program savings in 2014, the fact sheet said. Total net savings created by the MSSP for the Medicare trust funds were $465 million, according to the CMS.

The fact sheet noted that MSSP ACOs with more experience in the program were more likely to generate shared savings. “Among ACOs that entered the program in 2012, 37 percent generated shared savings, compared to 27 percent of those that entered in 2013, and 19 percent of those that entered in 2014.”

Quality Results 

According to the CMS fact sheet, Pioneer ACOs showed improvements in 28 of 33 quality measures and experienced average improvements of 3.6 percent across all quality measures compared to the 2013 results.

Pioneer ACOs demonstrated particularly “strong improvement” in measures for medication reconciliation, screening for clinical depression and follow-up plan and qualification for an electronic health record incentive payment, the fact sheet said.

MSSP ACOs that reported quality results in both 2013 and 2014 improved on 27 of 33 quality measures, the fact sheet said. “Quality improvement was shown in such measures as patients’ ratings of clinicians’ communication, beneficiaries’ rating of their doctor, screening for tobacco use and cessation, screening for high blood pressure, and Electronic Health Record use,” the CMS said.

In an Aug. 25 statement, acting CMS Administrator Andy Slavitt said the financial and quality results “show that accountable care organizations as a group are on the path towards transforming how care is provided.” He added, “Many of these ACOs are demonstrating that they can deliver a higher level of coordinated care that leads to healthier people and smarter spending.”

The CMS statement said that, since passage of the Affordable Care Act, more than 420 Medicare ACOs have been established, serving more than 7.8 million Americans as of Jan. 1, 2015.

To contact the reporter on this story: Michael D. Williamson in Washington at mwilliamson@bna.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bna.com