2014 Medicare ACO results: ACO leaders react

CMS announced Tuesday that 353 Medicare accountable care organizations generated $411 million in savings in 2014 and improved in most quality measures. About one in four Medicare ACOs — 97 total — qualified to share in these savings.

CMS said results showed marked improvement in quality and suggest ACO participation improves with prolonged participation. We checked in with the five leaders of ACOs — two Pioneers, one  Medicare Shared Savings Program and one organization that manages 25 MSSP ACOs, all of which shared in savings or had some ACOs share in savings per the results announced yesterday. Here, they discuss how their organizations fared in 2014 and their take on the progress of Medicare ACOs.

Participants include:

  • Emily Brower, vice president of population health at Atrius Health (Newton, Mass.).
  • Lisa Stevens Anderson, CEO of Banner Health Network (Mesa, Ariz.) and Shaun Anand, MD, CMO of Banner Health Network.
  • Katherine Schneider, MD, president and CEO of Delaware Valley ACO (Villanova, Pa.).
  • Jeffrey Spight, president of Collaborative Health Systems (White Plains, N.Y.).

Question: Does anything surprise you about the 2014 Medicare ACO results?

Emily Brower: We were delighted to see that the results continue to show overall savings for Medicare under value-based payment models. Value-based payment — holding the delivery system accountable for cost, quality and patient experience — is a model we have supported at Atrius Health for many years. Moving to value-based payment is important for the sustainability of our healthcare system and delivering the right care to patients and communities.

Lisa Stevens Anderson and Dr. Shaun Anand: We were pleased by the across-the-board improvements in clinical measures by all the participating ACOs, but not surprised. Banner Health Network remains focused on belief that accountable care is a key opportunity to address spiraling costs, while improving quality and the patient experience.

Dr. Katherine Schneider: This is the first year for DVACO's participation, so the process is new to us. The nature of the methodology does mean that you don't really know where you stand until the final adjustments are done, and while we knew we had trended in the right direction we were somewhat "on the fence" until the final release. Thus, we are very pleased to see how well we did.

Jeffrey Spight: There is certainly a lot of information to digest. The 2014 results do show that there are challenges in the existing MSSP structure, and it is disappointing that more ACOs will not be rewarded for delivering higher quality, more efficient care. We do believe the new rule changes that CMS will implement in 2016 will improve the business model for ACOs. We will continue to work with CMS and our ACO colleagues to make further improvements to create a long-term sustainable business model.

Q: How did your organization fare in terms of quality and savings in 2014?

Ms. Brower: Atrius Health had among the highest performance on the quality measures again this year — highest among Pioneer ACOs in New England and third highest nationally. These quality measures include care outcomes and patient experience, which is particularly important to us. We saved $4.5 million for Medicare in 2014, earning shared savings of $2.8 million for Atrius Health. We have a track record of being a lower cost provider for Medicare in our market, so we are especially pleased to have earned savings beyond our relatively low baseline expenditure.

Ms. Anderson and Dr. Anand: Banner Health Network delivered its best-ever result in a third successful year as part of the Pioneer ACO. We returned more than $29 million in savings over the predicted financial benchmark (5 percent), while at the same time improving our quality score by nearly 10 percent (quality score of 88). We believe this was possible as a result of engaged, high-performing provider partners, enabling technology and a variety of supportive clinical programs. We continue to identify opportunities for continuous advancement, including the further development of our technology infrastructure and maximizing each touch point along the care continuum.

Dr. Schneider: Our organization, partnering physicians and health systems fared well, with savings of $6.5 million, which means we are in the top 10 organizations [in terms] of shared savings earned. These early results speak to the challenging transformational work that has been taking place in our hospitals and physician practices — all with a focus on delivering superior care at a sustainable cost for our regional economy and the communities we serve.

Mr. Spight: Generally, we were pleased with how the ACOs in our network fared. Nine of our ACOs earned a shared savings payment in 2014, and an additional eight generated savings, but not enough to exceed the minimum savings rate. We were happy to see that in addition to the three ACOs that earned shared savings in the 2012/13 program years, including our flagship ACO in Houston, we saw tremendous progress across the portfolio in 2014, and in particular, for our ACOs in Maryland as well as our ACOs that operate Federally Qualified Health Centers. Add to that, all of our ACOs improved their quality score performance from last year to this year, which demonstrates that we are making a real impact in the communities our physician partners serve. Making the transition to value-based care is hard work, and the results demonstrate the success we've been able to achieve with our physician partners.

Q: How do you communicate these results with staff?

Ms. Brower: We communicate our performance regularly throughout the year to our staff. We also share our annual performance in coordination with Medicare's announcements, when we are able to compare our performance to the hundreds of ACOs nationally, including congratulations and thanks for the dedication and hard work that it takes to provide this high level of care to our patients.

Ms. Anderson and Dr. Anand: How don't we communicate these results with our staff? We use email, newsletters, letters, our employee intranet, face-to-face meetings, website content, slide presentations and video presentations. We want our team of employees, physicians and community partners to be aware of our collective result and recognize how their individual contributions made a difference.

Dr. Schneider: We at DVACO are very pleased with this early validation of our commitment to moving the business model of healthcare from one strictly based on volume to one based upon value, ultimately improving health outcomes and the patient care experience. These early results speak to the challenging transformational work that has been taking place in our hospitals and physician practices — all with a focus on delivering superior care at a sustainable cost for our regional economy and the communities we serve. On behalf of the entire DVACO team, I extend my deepest gratitude to our member physicians for their work thus far, and we am looking forward to continuing our partnership as we make significant progress in this complex transition to value-based care.

Mr. Spight: We work closely with the ACO physician leadership and provide them a comprehensive analysis of success factors and opportunities for improvement. There is a real science that is developing around understanding how the traditional Medicare delivery system operates and the levers we have to improve the quality and cost of care within the MSSP. We want to give our physician partners and staff not only an overview of their performance, but compelling insights that we are uniquely able to provide as a result of operating 25 ACOs around the country.


Note: This article was updated at 11:52 a.m. on August 26.

More articles on accountable care:

How are ACOs distributing their savings? 7 study findings
Walgreens, Providence Health to coordinate care through retail clinics
11 recent accountable care, shared savings agreements

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