Relationship between ACO Participation and Outcomes for High-Cost Populations

Accountable care organizations (ACOs) have the potential to substantially reduce Medicare spending for high-cost populations through enhanced care coordination and management.  However, the performance of ACOs in providing care to this patient population has not been assessed in prior studies.  KNG Health, in collaboration with Premier Research Institute and with funding from the Robert Wood Johnson Foundation, examined the effects of Medicare Shared Savings Program (MSSP) ACOs on quality and Medicare spending for select high-cost populations.  Using Medicare claims data, we examined outcomes for Medicare fee-for-service beneficiaries with asthma or chronic obstructive pulmonary (COPD) or that were hospitalized for pneumonia, heart failure, acute myocardial infarction (AMI), or total joint replacement (TJR), residing in the market areas of 21 ACOs.  We use propensity score matching and a difference-in-difference design to estimate the change in outcomes attributable to the MSSP ACOs.  We find that that for the majority of outcomes and conditions, participation in a MSSP ACO was not associated with changes in quality and Medicare spending for the high-cost patient populations examined during the first year of participation in the MSSP.  In general, the overall savings generated by saver ACOs were not driven by their performance in controlling spending for the high-cost populations examined.  Our finding raises questions about the ability of ACOs to effectively manage high-cost patient populations.  While these patients are expected to be targeted by ACOs due to their high use of healthcare services, they are also complex and may be difficult to manage.  It may take time for ACO effects to materialize for high-cost populations as ACOs figure out how to best manage these patient populations.

Services : Payment Policy & Delivery System Innovation, Program Evaluation and Monitoring Expertise: , ,