The care management provided by accountable care organizations (ACOs) participating in Medicare’s Next Generation ACO program is proving highly effective, according to a study published in the July issue of the American Journal of Managed Care (AJMC), with care management resulting in a 21-percent reduction in hospitalizations and a 22-percent reduction in costs.
The article, entitled “Effective Care Management by next Generation Accountable Care Organizations,” was written by Neal O’Hara, Olivia c. Tran, Shantanu Phatakwala, Anita Cattrell, Ph.D., and Yousself Ajami.
The researchers state that their objective in the study was “to estimate the utilization and spending impact of a standardized complex care management program implemented at 5 Next Generation accountable care organizations (NGACOs) and to identify reproducible program features that influenced program effectiveness.” Their study design? “In 2016 and 2017, high-risk Medicare beneficiaries aligned to 5 geographically diverse NGACOs were identified using predictive analytics for enrollment in a standardized complex care management program. We estimated the program’s impact on all-cause inpatient admissions, emergency department visits, and total medical expenditures (TME) relative to a matched cohort of nonparticipants. In a subanalysis, we studied the modifying effects of intervention fidelity on program impact.”
And the results of their study? “Program participation was associated with a 21-percent reduction in all-cause inpatient admissions (P = .03) and a 22-percent reduction in TME (P = .02) 6 months after program completion. Relative spending reductions were 2.1 times greater for high-fidelity interventions compared with overall program participation (P < .001).” As a result, they conclude, “Centrally staffed complex care management programs can reduce costs and improve outcomes for high-risk Medicare beneficiaries. Integrating predictive risk stratification, evidence-based intervention design, and performance monitoring can ensure consistent outcomes.”
Among the key findings:
> Program participation was significantly associated with reduced all-cause inpatient admissions (–21.2 percent) and lower total medical expenditures (–22.0 percent) compared with a propensity score–matched cohort of nonparticipants.
> The researchers identified specific program features that were significantly associated with intervention fidelity.
> Relative spending reductions were 1.9 times greater for high-fidelity interventions compared with overall program participation.
> Future accountable care organization leaders can use these findings to inform effective care management program design.
Importantly, the researchers note, “As of 2019, the 518 accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) coordinate care for 10.9 million fee-for-service (FFS) beneficiaries. More than 70 percent currently participate in upside-only tracks, but the Pathways to Success final rule requires that all future MSSP ACOs take on some level of downside risk within 2 years. Financial performance for participants in the 2-sided Next Generation ACO (NGACO) model varied widely, ranging from owed losses of $14 million to earned savings of nearly $30 million in 2017, highlighting the need for reproducible strategies that can improve outcomes and reduce spending.”
They researchers also note that “Most NGACOs implemented care management programs targeted at subpopulations with chronic comorbid diseases as a way to manage costs, but there are relatively few examples in the literature that demonstrate an association between complex care management programs and lower medical expenditures for participating beneficiaries. Findings from recently published success stories were limited to a single ACO site or based on a small sample size of Medicare FFS patients, which limits generalizability. To our knowledge,” they write, “there are no large-scale, multisite ACO studies that evaluate the impact of a standardized complex care management program on cost and utilization outcomes.”
