Four accountable care organization (ACO) models generated more in gross savings in 2016, but unlike in previous years, CMS hasn’t publicly touted the results as it re-examines payment models created under the Centers for Medicare and Medicaid Innovation (CMMI).
2016 featured the launch of a new model and the end of an older one. The new model, Next Generation, saw 11 of its 18 participants generated gross savings totaling $71 million, while the other seven ACOs owed $23 million in losses. The 11 ACOs were paid $58 million in bonuses with the money-losing organizations having to pay back $20 million in total. Miami-based Baroma Health Partners had the best performance, saving more than $12.2 million. All 18 ACOs in the program scored 100 percent on quality across 33 measures.
For the last year of the Pioneer ACO model, six of the eight remaining organizations (down from 32 at the start of the program) generated savings, while the other two broke even. Banner Health Network in Mesa, Ariz. topped the list with $10.9 million in savings. In total, they generated $37 million in shared savings, the same as in 2015.
What’s missing are the 2016 results of the larger Medicare Shared Savings Program (MSSP), which CMS should be released by the end of October. In 2015, MSSP ACOs earned move in bonuses than the program saved for CMS, though a more recent report from the HHS Office of the Inspector General (OIG) said program participants reduced Medicare spending by almost $1 billion over three years.
A CMS spokesperson told HealthExec that the four models—MSSP, Pioneer ACO, Next Generation ACO and the Comprehensive End-Stage Renal Disease Model—generated a combined $836 million in gross savings in 2016, nearly double the amount from 2015, when only the MSSP and Pioneer ACO models were being used. The spokesperson downplayed the significance of those results, however, saying they don’t account for “spillover effects of ACOs on the market” or the $701 million in bonus payments to 423 of the 471 MSSP ACOs.
The “spillover effects” the CMS spokesperson mentioned may be a reference to consolidation. Archway Health CEO Dave Terry said in a recent interview that CMS may be looking to de-emphasize ACOs to combat the consolidation trend as it retools CMMI.
“I think they have some concern around consolidation and we’ve seen ACO models drive consolidation of primary care physicians and merging them into large health systems and I think they’re wary of that with the ACOs,” Terry said to HealthExec.
A Feb. 2017 study published in Health Affairs challenged the tie between ACOs and consolidation, finding markets with greater ACO participation in 2014 didn’t experience changes in physician-hospital integration or other measures of market concentration. In fact, it found only evidence of defensive consolidation—practices and hospitals merging in order to avoid entering into risk-based contracts, not to succeed in them.