CMS unveils 2015 Medicare ACO quality, financial performance: 12 things to know

CMS on Thursday released the 2015 quality and financial results for its Pioneer and Medicare Shared Savings Programs. Despite that less than a third of ACOs earned shared savings payments, the data suggests Medicare ACOs are improving over time in both generating savings and improving quality.

Here are 12 things to know about the results.

Combined programs

1. Under both the Pioneer and MSSP models, 125 ACOs qualified to earn shared savings payments — representing just 31 percent of all Medicare ACOs in 2015. Earning shared savings payments indicates the ACOs met quality performance standards and their savings threshold.

2. Including both generated savings and losses, the 404 participating ACOs generated total program savings of $466 million.

3. Compared to 2014, performance has improved. In 2014, only 27 percent of all Medicare ACOs shared in savings and the programs generated total savings of $422 million. This indicates the ACOs perform better with more experience, according to CMS.

4. Since 2012, the Medicare ACO programs have generated $1.29 billion in total Medicare savings.

Pioneer Model

5. The Pioneer ACOs made significant improvements in quality in 2015. Nine of the 12 ACOs had quality scores above 90 percent, and all ACOs in the program improved their quality scores to a mean of 92.26 percent from 87.2 percent in 2014. Pioneer ACOs have consistently raised the bar in terms of quality year over year, according to CMS. Each of the dozen ACOs that remain in the program have improved their quality scores by over 21 percentage points since 2012.

6. The 2015 financial results were not so rosy for all Pioneer ACOs. One third of the cohort generated losses, and one — Peoria, Ill.-based OSF HealthCare ACO — owed shared losses. It had to pay $1.6 million back to CMS. However, eight of the 12 did generate savings for Medicare, and six were able to share in those savings. Overall the program's net savings was $37 million.  

7. The Pioneer ACOs were evaluated under slightly different parameters in 2015. The program changed its financial benchmarking in 2015. It also "re-based" the ACOs, meaning it changed the baseline years used to set financial benchmarks to the initial years of participation in the program.  

8. Though program participation dropped, the ACOs themselves grew in 2015. The 12 Pioneers oversaw care for more than 460,000 beneficiaries in 2015 — a 24 percent average increase in beneficiaries per ACO, year over year.

Medicare Shared Savings Program

9. Of the 392 ACOs participating in MSSP, 119 earned shared savings. Eighty-three kept costs below their benchmark, but did not meet minimum savings requirements and were unable to share in savings. The net savings for Medicare was $429 million.

10. This marks steady growth in the proportion of ACOs that have generated shared savings since 2013, according to CMS. The results also show ACOs are more likely to generate savings with more experience in the program. In 2015, 42 percent of the ACOs that have participated since 2012 earned shared savings, compared to 37 percent of those that started in 2013 and 22 percent that started in 2014.

11. Most MSSP ACOs — 91 percent — in their second or third performance year improved overall quality performance. Within the overall scores, the average quality performance improved by more than 15 percent from 2014 to 2015 in four measures in particular: screening for fall risk, depression screening and follow-up, blood pressure screening and follow-up and administering pneumonia vaccinations.

12. CMS reported that eligible professionals within the MSSP ACOs satisfied quality reporting measures in 2015, allowing them to avoid the 2017 Physician Quality Reporting System payment adjustment and Value Modifier downward adjustment.

 

More articles on accountable care:

9 recent accountable care, shared savings agreements
Could ACOs inadvertently be making healthcare disparities worse?
High-value primary care providers are the secret to ACO success

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