A just-published analysis finds that accountable care organizations (ACOs) working to serve rural and underserved populations have been making a difference in terms cost reduction, compared to the cost profiles of providers not involved with ACOs.
A team of healthcare policy researchers—Matthew J. Trombley, Ph.D., Betty Fout, Ph.D., Sasha Brodsky, Ph.D., J. Michael McWilliams, M.D., Ph.D., David J. Nyweide, Ph.D., and Brant Morefield, Ph.D.—has analyzed the outcomes of the accountable care organizations (ACOs) participating in the ACO Investment Model (AIM), designed to grow the Medicare Shared Savings Program (MSSP).
The article, published online on Aug. 8 in The New England Journal of Medicine online , was entitled “Early Effects of an Accountable Care Organization Model for Underserved Areas.” It begins, “The Centers for Medicare and Medicaid Services (CMS) developed the Accountable Care Organization (ACO) Investment Model (AIM) to encourage the growth of Medicare Shared Savings Program (MSSP) ACOs in rural and underserved areas. AIM provides financial support to eligible MSSP ACOs by means of prepayment of shared savings. Estimation of the performance of AIM ACOs on measures of spending and utilization in their first performance year would be useful for understanding the viability of ACOs located in these areas.”
In that regard, the researchers write, “We analyzed Medicare claims and enrollment data for a group of fee-for-service beneficiaries who had been attributed to 41 AIM ACOs and for a comparable group of beneficiaries who resided in the ACO markets but were served primarily by non-ACO providers. We used a difference-in-differences study design to compare changes in outcomes from the baseline period (2013 through 2015) to the performance period (2016) among beneficiaries attributed to AIM ACOs with concurrent changes among beneficiaries in the comparison group. The primary outcome of interest was total Medicare Part A and B spending.”
What did they find? The researchers write, “Provider participation in AIM was associated with a differential reduction in total Medicare spending of $28.21 per beneficiary per month relative to the comparison group, which amounted to an aggregate decrease of $131.0 million. Over the same period, CMS made $76.2 million in prepayments and paid an additional $6.2 million in shared savings to ACOs in which shared savings exceeded the prepayments. After we accounted for this $82.4 million in CMS spending, the aggregate net reduction was $48.6 million, which corresponded to a net reduction of $10.46 per beneficiary per month. Decreases in the number of hospitalizations and use of institutional post-acute care contributed to the observed reduction in overall spending.”
As a result, the researchers write, “With up-front investments, participation in ACO shared savings contracts by providers serving rural and underserved areas was associated with lower Medicare spending than that among non-ACO providers.” The researchers received funding from CMS for their analysis.
