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How Medicare ACOs Fared Financially in 2015: A Visual Analysis

August 30, 2016
by Rajiv Leventhal
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Last week, the Centers for Medicare & Medicaid Services (CMS) released 2015 financial and quality performance results for accountable care organizations (ACOs) in two federal programs—the Medicare Shared Savings Program (MSSP) and the Pioneer ACO Program.

ACOs are judged on their performance, as well as their improvement, on an array of metrics that assess the care they deliver. Those metrics include how highly patients rated their doctor, how well clinicians communicated, whether patients are screened for high blood pressure, and their use of electronic health records (EHRs). The number of Medicare beneficiaries served by ACOs continues to grow, according to CMS officials. And, as the government continues to set the goal of having 50 percent of traditional Medicare payments flowing through alternative payment models by 2018, tracking ACO progress will be crucial as the healthcare system continues to move towards one that pays providers for the value of care they deliver, rather than volume.

As Healthcare Informatics Editor-in-Chief Mark Hagland opined in a commentary last week following the release of the data, CMS officials were quick to laud the progress of ACOs in both federal programs. Indeed, with the announcement from CMS came a whole lot of numbers and statistics, many of which can be tough to interpret in word form, and many of which could tell different stories depending on how one reads them. As such, Healthcare Informatics has put together a series of visuals that we think will help readers better conceptualize how ACOs performed financially in 2015, in some cases using previous years’ statistics as a baseline. Below are six graphics, with analysis for context, that help explain how Medicare ACOs are performing. 

Analysis: Collectively, Medicare ACOs have generated more than $1.29 billion in total Medicare savings since 2012. In 2015, 404 Medicare ACOs saved $466 million. This number represents an increase over total Medicare ACO savings from the previous two years. (Note: the Pioneer ACO Program began in 2012, while the MSSP’s first year was 2013).

Analysis: In the Pioneer ACO Program, there were eight out of 12 ACOs in this model (blue plus red slices) that generated some savings last year, six of whom (blue) generated savings outside a minimum savings rate and earned bonuses. Four of the 12 Pioneer ACOs (orange) failed to save at all in 2015. Additionally, not shown here, of those four organizations that generated losses, one (OSF Healthcare System, Peoria, Ill.) generated losses outside a minimum loss rate and had to give $1.6 million back to CMS.

Analysis: For MSSP ACOs in 2015, 119 of the 392 organizations (30 percent) earned shared savings, while 83 of 392 ACOs in this model, or 21 percent, earned some savings, but not enough to garner bonuses. Meanwhile, 190 of 392 MSSP ACOs (48 percent) generated no savings at all last year.

Analysis: In sum, 279 of the 404 total Medicare ACOs, or 69 percent (orange plus red slices), did not generate savings outside a minimum savings rate to earn shared savings. These results are similar to 2014 totals, when in sum, 71 percent of Medicare ACOs did not receive bonuses based on their savings.

Analysis: The Pioneer ACO program began with 32 ACOs in 2012, but is now down to 12 after the majority of the organizations have dropped out. Indeed, participation in this program continues to dwindle, though several of the ACOs who dropped out will join other models, such as CMS’ Next Generation ACO Model, which began at the start of 2016. ACOs in the Next Generation ACO Model will take on greater financial risk than those in current Medicare ACO initiatives, while also potentially sharing in a greater portion of savings.

Analysis: ACOs with more experience in the Medicare Shared Savings Program tend to perform better over time. For performance year 2015, 42 percent of ACOs that started in 2012 generated savings above their minimum savings rate (MSR), compared to 37 percent of 2013 starters, 22 percent of 2014 starters and 21 percent of 2015 starters.