High Hurdles: Leaders of Patient Care Organizations Participating in Medicare's ACO Programs are Pushing Ahead Into the New Healthcare

The leaders of ACOs are working their way through a welter of immediate and longer-term issues.

With 368 Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) nationwide, and, according to recent estimates, well over 500 ACOs of some kind, including an ever-expanding group of collaborative arrangements between private health insurers and provider groups, the ACO concept is moving inexorably forward in U.S. healthcare. Indeed, even some of the challenges inherent in the shift to the ACO delivery-and-payment model—such as the announcement a year ago that seven of the Pioneer Medicare Shared Savings Program (MSSP) participant entities were shifting to regular MSSP status after failing to produce the level of cost savings expected of them under the terms of the Pioneer MSSP program, and two were leaving the MSSP program altogether—are leading to intensified work to ramp up ACO cost savings and outcomes gains.

(A Leavitt Partners analysis published in the Health Affairs blog in June found that “The Pioneer program generated $147 million in total savings [in 2012], with approximately $76 million in savings returned to ACOs. Of the original 32 Pioneer ACOs, 12 shared in savings, while 19 did not share in savings or losses. Only one ACO shared in losses.” Meanwhile, as that same analysis found, “Of the 114 MSSP ACOs”—the non-Pioneer ACOs—“54 kept costs below budget benchmarks and 29 of those saved more than 2 percent, thus qualifying for shared savings.”)

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Souce: Healthcare Informatics