Archive for ACO

 

MedPAC Meets

Last week the Medicare Payment Advisory Commission held two days of public meetings in Washington, D.C.

During the sessions MedPAC, a non-partisan legislative branch agency that advises Congress on Medicare payment issues, addressed the following subjects:

  • a Medicare Advantage status report
  • a Medicare prescription drug program (Part D) status report
  • hospital inpatient and outpatient payments
  • physician payments
  • ambulatory surgical center, dialysis center, and hospice payments
  • post-acute care facility payments
  • the hospital readmissions reduction program
  • telehealth
  • accountable care organizations

Go here to see the issue briefs and presentations used during the meetings.…

Reduced Hospitalizations and Improved Care for High-Risk Patients Not Driving ACO Savings

Medicare savings reported in the early years of the Medicare Shared Savings Program are not coming from reduced hospitalizations of high-risk Medicare patients or even through better coordination of care for those patients.

Instead, Medicare accountable care organization savings are coming mostly from better and more coordinated care for low-risks Medicare ACO participants.

These surprising findings are reported in the article “Medicare ACO Program Savings Not Tied To Preventable Hospitalizations Or Concentrated Among High-Risk Patients,” which can be found in the December 2017 edition of the journal Health Affairs.  Find a link to that article here.…

Medicare ACOs Showing Promise

Medicare’s Shared Savings Program and its accountable care organizations are showing promise as a means of reducing Medicare spending and improving the quality or care.

Or so concludes the U.S. Department of Health and Human Services’ Office of the Inspector General.

According to a new OIG report,

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. At the same time, ACOs generally improved the quality of care they provided, based on CMS data on quality measures. In the first 3 years, ACOs improved their performance on most (82 percent) of the individual quality measures. 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. 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

ACOs, APMs Proliferate

The number of accountable care organizations and alternative payment models is growing, as is the number of people served by such programs.

According to a new study published on the Health Affairs Blog, there are more than 900 ACOs across the country – a 10 percent increase over a year ago.

32 million Americans are served by ACOs today – 2.2 million more than a year ago.  Among them, 59 percent are served through commercial contracts, 29 percent by Medicare contracts, and 12 percent under Medicaid contracts.  ACO growth is greatest in metropolitan areas, the states with the greatest ACO penetration are Rhode Island and Maine, and the states with the least ACO penetration are Wyoming and West Virginia.

Among alternative payment models, growth is greatest among shared-savings and shared-risk ACOs, include episode-based models and partially- and fully-capitated payments for patient populations.  Today, APMs account for more than 30 percent of Medicare payments, with the greatest number, by far, participating in Medicare’s Comprehensive Primary Care Plus Model, followed by Medicare’s Comprehensive Care for Joint Replacement and Shared Savings Program models.

Learn more about the growth of ACOs and APMs, the current policy environment for such approaches, and possible future …

Serving High-Need, High-Cost Medicare Patients

With Medicare beneficiaries who have four or more chronic conditions accounting for 90 percent of Medicare hospital readmissions and 74 percent of Medicare costs (both 2010 figures), policy-makers are constantly looking for better ways to serve such individuals.

Academic research suggests that these beneficiaries need a variety of non-medical social interventions and supports, most of which are not covered by Medicare.

With this in mind, the Bipartisan Policy Center has prepared a review of current regulatory, payment, and other barriers that prevent providers and insurers from meeting some of the non-medical needs of high-need, high-cost patients that result in such high health care costs and hospital readmissions rates.

Among the care models this review considers are Medicare Advantage plans, Medicare Advantage Dual-Eligible Special Needs Plans, Medicare Shared Savings Program Accountable Care Organizations, Next Generation ACOs, Comprehensive Primary Care Plus Model Participants, and Programs for All-Inclusive Care for the Elderly (PACE).

Find this all in the Bipartisan Policy Center report Challenges and Opportunities in Caring for High-Need, High-Cost Medicare Patients, which is available here.…