NAACOS Plenary: Cavanaugh Calls ACO Program Results Heartening

Laura Joszt

Despite some skeptical coverage of the most recent results of the Medicare accountable care organization (ACO) program, these results are actually heartening, said Sean Cavanaugh, deputy administration and director of the Center for Medicare at CMS.
 
During the plenary session on the first day of the fall meeting of the National Association of ACOs, Cavanaugh discussed the outcomes of the Medicare ACO programs and members of 2 successful ACOs joined him on stage to provide their input.
 
While coverage of the most recent results of the Medicare ACO programs reported that fewer than one-third (31%) of ACOs generated shared savings, Cavanaugh said that he found the results heartening after drilling deeper into the data. For example, every cohort has, on average, improved year to year.
 
“The longer an ACO is in the program, the better they do on quality,” he said.
 
So while just 31% of all ACOs participating shared in savings, the reality was that the newer ACOs were “diluting the successes” of the older ones. Of the ACOs that started the program in 2012, 42% shared in savings, which is a big difference, he pointed out.
 
“I think that’s a very different narrative on this program,” he said, adding that perhaps expectations needed to be slightly altered.
 
“ACOs that are 1 or 2 years old, maybe we shouldn’t expect big things from them yet,” he said.
 
Beneficiary attestation is another area CMS is looking to address, Cavanaugh said. The agency is proposing to move forward with some way for a beneficiary to say that he or she wants to be attributed to a specific doctor, regardless of what is on the claims and the doctor’s ACO.
 
Jeff Spight, of Universal American, followed Cavanaugh to discuss why some ACOs see success. The biggest reason is the relationships and the work of physicians and their staff.
 
“This is a behavioral change, a cultural change,” Spight said.
 
The Medicare ACO programs are entering an interesting phase, he said, because for a long time it has all been an experiment or a pilot to test things out. However, it is now time to pivot away from that thinking to become a permanent part of the healthcare delivery system.
 
“ACOs are not going anywhere,” Spight said. “We need to figure out how we make ourselves a permanent part of [healthcare delivery]. Stop talking about it like it’s something that is potentially going to go away. We are here to stay.”
 
Ultimately, it is up to the ACOs to do a better job of marketing what they do and the changes they are making for the good of the ACO program.
 
Changing is essential for ACOs, David Klebonis of Doctors ACO said. The business of an ACO should be changing if an ACO wants to succeed.
 
“If you change nothing, your payment is very precise: it’s nothing,” Klebonis said.
 
Changing the business means doing a better job of getting physicians engaged, because many ACOs have some physicians that have changed their practice, but many others that have done nothing. The ACO needs to address those physicians and find out what the ACO needs to do to help foster a change in a physician’s behavior.
 
Klebonis echoed the previous comments from Cavanaugh and Spight, who both said that ACO successes need to be promoted better in order to combat the negative propaganda facing the program.
 
Cavanaugh and CMS remain supporters of the Medicare ACO program. “We feel that there has been a lot of misunderstanding about how the program works from skeptics, but that the program is genuinely working,” he said.
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