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Medicare program shared savings accountable care organizations have shown potential for reducing spending and improving quality

Series Title(s):
Report in brief
Contributor(s):
United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
Publication:
[Washington, D.C.] : U.S. Department of Health and Human Services, Office of Inspector General, August 2017
Language(s):
English
Format:
Text
Subject(s):
Accountable Care Organizations
Cost Savings
Cost Sharing
Medicare
Quality of Health Care
Cost Control
Facilities and Services Utilization -- statistics & numerical data
Fee-for-Service Plans
Health Expenditures
Quality Indicators, Health Care
Humans
United States
United States. Department of Health and Human Services.
Genre(s):
Technical Report
Abstract:
Why OIG Did This Review. Medicare spending is expected to grow to $1.4 trillion by 2027. To control this increase and promote quality and healthy populations, the Centers for Medicare & Medicaid Services (CMS) has implemented and is considering a number of alternative payment models that reward providers for the quality and value of services. The goal is to incentivize providers to keep patients healthy and thus lower costs. The Medicare Shared Savings Program is one of the largest alternative payment models. As part of this program, health care providers form Accountable Care Organizations (ACOs) to coordinate care to reduce costs and improve quality of care. Information about the extent to which ACOs are able to reduce Medicare spending and improve quality is critical to inform future developments as ACOs and other alternative payment models evolve. How OIG Did This Review. We analyzed beneficiary and provider data from CMS to describe the characteristics of ACOs. We also analyzed spending and quality data to determine the extent to which ACOs reduced Medicare spending and improved quality in the first 3 years of the program. Lastly, we analyzed spending and utilization data to describe how high-performing ACOs reduced spending and made changes to utilization for key services. What OIG Found. Over the first 3 years of the program, 428 participating Shared Savings Program ACOs served 9.7 million beneficiaries. During that time, most of these ACOs reduced Medicare spending compared to their benchmarks, achieving a net spending reduction of nearly $1 billion. One-third of ACOs reduced spending enough to receive a portion of the savings. ACOs participating in the program longer were more likely to reduce spending and by greater amounts than other ACOs. This suggests that more established ACOs are learning how to achieve greater cost savings over time. At the same time, ACOs generally improved the quality of care they provided, based on CMS's data on quality measures. In the first 3 years, ACOs improved their performance on most (82 percent) of the individual quality measures. These 33 measures track various aspects of care provided to beneficiaries, such as the percentage of beneficiaries screened for depression. ACOs also outperformed fee-for-service providers on most (81 percent) of the quality measures. Further, a small subset of ACOs showed substantial reductions in Medicare spending while providing high-quality care. These high-performing ACOs reduced spending by an average of $673 per beneficiary for key Medicare services during the review period. This included significant spending reductions for high-cost services such as inpatient hospital care and skilled nursing facility care. These ACOs also maintained high use of primary care services, which can lower utilization and costs for other care, and reduced the use of costly services such as emergency department visits. In contrast, other Shared Savings Program ACOs and the national average for fee-for-service providers showed an increase in per beneficiary spending for key Medicare services. With any major payment reform, time may be needed for organizations to make changes to improve quality and lower costs. While policy changes may be warranted, ACOs show promise in reducing spending and improving quality. However, additional information about high-performing ACOs would inform the future direction of the Shared Savings Program as well as other alternative payment models
Copyright:
The National Library of Medicine believes this item to be in the public domain. (More information)
Extent:
1 online resource (1 PDF file (39 pages))
Illustrations:
Illustrations
NLM Unique ID:
101737819 (See catalog record)
Series Title(s):
Report in brief
Contributor(s):
United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
Publication:
[Washington, D.C.] : U.S. Department of Health and Human Services, Office of Inspector General, August 2017
Language(s):
English
Format:
Text
Subject(s):
Accountable Care Organizations
Cost Savings
Cost Sharing
Medicare
Quality of Health Care
Cost Control
Facilities and Services Utilization -- statistics & numerical data
Fee-for-Service Plans
Health Expenditures
Quality Indicators, Health Care
Humans
United States
United States. Department of Health and Human Services.
Genre(s):
Technical Report
Abstract:
Why OIG Did This Review. Medicare spending is expected to grow to $1.4 trillion by 2027. To control this increase and promote quality and healthy populations, the Centers for Medicare & Medicaid Services (CMS) has implemented and is considering a number of alternative payment models that reward providers for the quality and value of services. The goal is to incentivize providers to keep patients healthy and thus lower costs. The Medicare Shared Savings Program is one of the largest alternative payment models. As part of this program, health care providers form Accountable Care Organizations (ACOs) to coordinate care to reduce costs and improve quality of care. Information about the extent to which ACOs are able to reduce Medicare spending and improve quality is critical to inform future developments as ACOs and other alternative payment models evolve. How OIG Did This Review. We analyzed beneficiary and provider data from CMS to describe the characteristics of ACOs. We also analyzed spending and quality data to determine the extent to which ACOs reduced Medicare spending and improved quality in the first 3 years of the program. Lastly, we analyzed spending and utilization data to describe how high-performing ACOs reduced spending and made changes to utilization for key services. What OIG Found. Over the first 3 years of the program, 428 participating Shared Savings Program ACOs served 9.7 million beneficiaries. During that time, most of these ACOs reduced Medicare spending compared to their benchmarks, achieving a net spending reduction of nearly $1 billion. One-third of ACOs reduced spending enough to receive a portion of the savings. ACOs participating in the program longer were more likely to reduce spending and by greater amounts than other ACOs. This suggests that more established ACOs are learning how to achieve greater cost savings over time. At the same time, ACOs generally improved the quality of care they provided, based on CMS's data on quality measures. In the first 3 years, ACOs improved their performance on most (82 percent) of the individual quality measures. These 33 measures track various aspects of care provided to beneficiaries, such as the percentage of beneficiaries screened for depression. ACOs also outperformed fee-for-service providers on most (81 percent) of the quality measures. Further, a small subset of ACOs showed substantial reductions in Medicare spending while providing high-quality care. These high-performing ACOs reduced spending by an average of $673 per beneficiary for key Medicare services during the review period. This included significant spending reductions for high-cost services such as inpatient hospital care and skilled nursing facility care. These ACOs also maintained high use of primary care services, which can lower utilization and costs for other care, and reduced the use of costly services such as emergency department visits. In contrast, other Shared Savings Program ACOs and the national average for fee-for-service providers showed an increase in per beneficiary spending for key Medicare services. With any major payment reform, time may be needed for organizations to make changes to improve quality and lower costs. While policy changes may be warranted, ACOs show promise in reducing spending and improving quality. However, additional information about high-performing ACOs would inform the future direction of the Shared Savings Program as well as other alternative payment models
Copyright:
The National Library of Medicine believes this item to be in the public domain. (More information)
Extent:
1 online resource (1 PDF file (39 pages))
Illustrations:
Illustrations
NLM Unique ID:
101737819 (See catalog record)