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October 05, 2018

ACOs Had No Significant Impact on Spending for Patients With Cancer

Laura Joszt
Accountable care organizations (ACOs) have not had a significant impact on cancer care costs and utilization. While cancer care costs did decline from before the introduction of ACOs to after, there was no significant difference in spending decreases between ACO practices and non-ACO practices caring for patients with cancer.
While accountable care organizations (ACOs) have been shown generally to reduce costs for patients compared with similar patients who didn’t receive care in an ACO, the same cannot be said for cancer care in ACOs. While ACO practices did reduce costs for cancer care, they didn’t do so at a more significant rate than non-ACO practices during the same time.

A study in the Journal of Clinical Oncology, the journal of the American Society of Clinical Oncology, compared patients with cancer who were treated at ACO practices with those treated at non-ACO practices in the same geographic region.

With the high cost of cancer care and the incidence of cancer expected to increase as the population ages, “it is critically important to understand how broad policy efforts to control health care spending are impacting the care of patients with cancer,” the authors wrote.

The researchers analyzed a 20% sample of Medicare fee-for-service beneficiaries using 2011 to 2015 Medicare Research Identifiable files. They matched practices that became part of an ACO to non-ACO practices in the same region and calculated costs and utilization for beneficiaries.

The analysis did find that total mean spending per beneficiary was significantly different between ACO and non-ACO patients in the pre-ACO period ($18,909 vs $18,458, respectively), but that decrease in spending for ACO patients (–$308) was not significantly different from the decrease in spending for non-ACO patients (–$319).

The data showed a significant increase in outpatient spending from the pre- to post-ACO period, but the increases were not significantly different between ACO and non-ACO patients. In comparison, radiation therapy and chemotherapy spending decreased between the pre- and post-ACO era, but there were no differences in the decreases between the 2 groups.

The authors postulated a few reasons why ACO practices didn’t reduce spending or utilization much more than non-ACO practices. For instance, cancer care is complex and requires coordination across a variety of providers and settings, and it can be difficult to implement strategies to reduce utilization across settings. Second, technological advances and novel devices and drugs have contributed to the increasing cost of cancer care. Third, ACOs may have been targeting other chronic diseases.

Lastly, oncology providers have been engaged in multiple initiatives to promote value and alternative ways to deliver and pay for care, such as the Oncology Care Model and oncology medical homes, which could have resulted in widespread improvements that simultaneously affect both ACO and non-ACO patients.

“Although it may be too early to see an impact of ACOs on patients with cancer, it is also possible that ACOs may need to explicitly focus on patients with cancer to improve their care and reduce unnecessary spending,” the authors concluded.


Lam MB, Figueroa JF, Zheng J, Orav EJ, Jha AK. Spending among patients with cancer in the first 2 years of accountable care organization participation. J Clin Oncol. 2018;36(29):2955-2960. doi: 10.1200/JCO.18.00270.

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