Study: How this Pioneer ACO reduced Medicare costs by 6%

Based on an in-depth analysis of a Pioneer ACO, researchers determined ACOs with integrated care management programs are both effective and scalable methods to reduce utilization and spending.

The study, published in Health Affairs, examined hospitalization rates, emergency department visits and Medicare spending for beneficiaries aligned in 2012 or 2013 with the Partners ACO, part of Boston-based Partners HealthCare. The researchers used Medicare claims data from 2009 to 2014.

Partners ACO used a strategy that proved to be highly effective, according to the study. This strategy involved identifying beneficiaries at high-risk for future spending, targeting those within that group with potentially modifiable spending and then enrolling them in an intensive care management program. This program was developed at a Partners HealthCare hospital ahead of the system's participation in the Pioneer program. Through the Medicare Care Management for High Cost Beneficiaries Demonstration, Boston-based Massachusetts General Hospital already had a tried and tested intensive care management program. When Partners joined the Pioneer program, it rolled this care management program out across its hospitals.

Due to capacity constraints, enrollment was staggered for patients eligible for the care management program. This allowed researchers to isolate the effects of the program within the ACO overall in the study.

While the ACO was effective in driving lower ED visits, hospital visits and Medicare spending, much of the reduction appears to be attributable to the care management program, according to the study. For example, researchers found overall ACO participation was associated with a $14 reduction in Medicare spending per beneficiary per month, which was about a 2 percent reduction in spending. However, the care management program was associated with a $101 reduction in Medicare spending per beneficiary per month — a 6 percent reduction in spending.

The care management program was also associated with an 8 percent reduction in hospitalization rates and a 6 percent reduction in ED visits. The researchers wrote that the strategies the ACO used to reduce utilization — offering alternative communication channels with providers and encouraging use of lower intensity sites of care — suggest the reduction will be sustainable over time.

The study also demonstrates that intensive care management can be scaled across an organization. Partners ACO was able to successfully scale and spread this program across a variety of providers, even community-based physicians affiliated with smaller hospitals who have significantly different workflows, according to the report.

"Targeting beneficiaries with modifiable high risks and shifting care away from the ED represent viable mechanisms for altering spending within ACOs," they conclude.

 

More articles on accountable care organizations:

Global foundation to roll out value-based cardiac care pilot in Atlanta
PCMHs in Michigan successfully reduce ED, hospital use and costs
Study: Turnover may be why ACOs have weak influence on cost, outcomes

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