Carrie H. Colla, Valerie Lewis, L.-S. Kao, A. J. O'Malley, C.-H. Chang, and E. S. Fisher
C. H. Colla, V. A. Lewis, L.-S. Kao et al., “Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries,” JAMA Internal Medicine, published online June 20, 2016.
Enrollment in Medicare accountable care organizations (ACOs) is associated with reductions in health spending as well as fewer emergency department visits and hospitalizations. This is particularly true for beneficiaries with multiple medical conditions. Following implementation of Medicare ACOs, total spending overall decreased by $136, or 1.3 percent, annually per beneficiary, and by $456, or 2 percent, for those beneficiaries with multiple conditions.
Accountable care organizations have the potential to deliver better coordinated care and lower overall health costs. Today there are more than 700 ACO contracts in place, covering 23 million Americans. A Commonwealth Fund–supported study looked at the effect of ACOs on health care spending and use on a subgroup of Medicare beneficiaries who were “clinically vulnerable”—they had at least three chronic or acute conditions, such as diabetes, heart disease, and cancer.
"Medicare ACO programs are associated with modest savings on average across all beneficiaries, with savings concentrated in clinically vulnerable beneficiaries and use of institutional settings."
These results suggest that the ACO model produces modest early benefits in terms of reduced spending and reduced emergency department and hospital use, particularly for patients with multiple clinical conditions. Further research is needed to determine the longer-term effects of ACOs, write the authors, “as it is likely that while some relatively simple changes may have shown rapid results, more structural changes will take time to produce improvements in health care outcomes.”
The researchers used five years of Medicare data (2009–2013) to compare changes in spending and use of services for beneficiaries cared for by physicians in ACOs and those cared for by non-ACO physicians. The study included Medicare beneficiaries, and a subpopulation of clinically vulnerable Medicare beneficiaries who had at least three “hierarchical condition categories,” as defined by the Centers for Medicare and Medicaid Services. These included congestive heart failure, arrhythmias, chronic obstructive pulmonary disease, renal failure, vascular disease, diabetes, and cancer, among others.
Medicare accountable care organizations are associated with modest reductions in spending, hospitalizations, and emergency department visits. The greatest benefits are for beneficiaries with multiple medical conditions.