In the first study, Boston-based Harvard Medical School researchers analyzed beneficiaries’ fee-for-service Medicare claims in ACOs to claims in non-ACOs before and after they started the Medicare Shared Savings Program.
The samples included more than 8.3 million hospital admissions and more than 1.5 million skilled nursing facility stays.
Here are four findings from the first study:
1. The 114 ACOs had a 9 percent reduction in post acute spending from 2012 to 2014. These savings translate to $108 less per beneficiary, when comparing ACOs to the non-ACOs.
2. This reduction was due to hospitals discharging patients home and by limiting the length of stay in facilities and acute inpatient care.
3. Researchers noted the ACOs accrued these cost savings over time, and the majority occurred in skilled nursing facilities. J. Michael McWilliams, MD, PhD, a study researcher, said, “SNFs are the facilities with the strongest incentive to keep patients as long as possible because they are paid on a per diem basis.”
4. Independent physicians either fared equal-to or better-than hospital-based ACOs in truncating costs.
In the second study, Portland-based Oregon Health and Science University researchers compared two different Colorado and Oregon Medicaid ACOs’ early results.
Colorado launched its Accountable Care Collaborative in 2011. The collaborative featured seven regional care collaborative organizations that received funding on a per-member, per-month basis. Participating providers did not face an upside or downside financial risk in this model.
Oregon officials used a $1.9 billion federal government investment to create 16 coordinated care organizations in 2012. All the groups had responsibility for patient care using a global budget. Participating organizations did however take on full financial risk.
Here are two findings:
1. Both states experienced similar rates in cost reductions despite their ACOs’ varying structures.
2. K. John McConnell, PhD, who led the study, noted many medical community members discount ACOs’ effectiveness as they only look at their early findings. His study found ACOs yield substantial savings over time and increase if there are more incentives to save.
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