Shortly after the federal Centers for Medicare & Medicaid Services (CMS) announced the latest results coming out of the two main accountable care organization (ACO) programs operating under the aegis of the Medicare program, the Medicare Shared Savings Program for accountable care (MSSP) and the Pioneer ACO Program, leaders at the Charlotte-based Premier, inc. were able to trumpet positive results coming out of Premier’s population health initiative.
As the statement attributed to Joe Damore, vice president, population health management, at Premier, noted, “Members of the Premier healthcare alliance commend all 353 participating care providers on the successes of the Medicare Shared Savings Program (MSSP) and the Pioneer Accountable Care Organization (ACO) Program for their notable quality improvements and $411 million in total savings. We believe ACOs hold great promise and are particularly pleased that more than 45 percent of the MSSP and Pioneer ACOs participating in Premier’s population health management collaborative, one of the largest ACO collaboratives in the country, qualified for shared savings payments,” Damore’s statement said. “Critical to their success, collaborative members focus on 10 key strategies to operate a highly-successful population health management entity, including benchmarking performance with peers, population health data management, leveraging a gap assessment tool and sharing best practices.
Futhermore, the statement stated that “All participants deserve credit for taking accountability for the quality and cost of care for a defined population. This is difficult work that requires new capabilities and investments. Moreover, the Centers for Medicare & Medicaid Services (CMS) model is evolving and we believe additional steps need to be taken, which we outlined in our recommendations to CMS.”
In fact, Damore reported to HCI Editor-in-Chief Mark Hagland, the details of Premier’s ACO collaborative’s progress are particularly positive. Here’s how the numbers stack up: in 2014, 181 of the 333 MSSP ACOs generated some level of savings, while 152 ACOs in that program generated no savings; and 15 of the 20 ACOs in the Pioneer ACO Program generated some level of savings, while five generated none. Expressed in terms of percentages, 55 percent of MSSP ACOs generated some level of savings, while 45 percent generated none; meanwhile, 75 percent of Pioneer ACOs generated some level of savings, while 25 percent generated none.
Meanwhile, among ACOs involved in Premier, Inc.’s ACO collaborative, the 2014 results were as follows, Damore noted: 50 percent of the Pioneer ACOs in Premier’s collaborative achieved some level of savings, while that same percentage, 50 percent, also received shared savings payments from CMS. Meanwhile, 63 percent of MSSP ACOs in Premier’s collaborative achieved some level of savings, and 47 percent received shared savings payments from CMS.
In other words, among the MSSP ACOs participating in Premier’s collaborative, 63 percent achieved some level of savings, compared with 55 of MSSP ACOs overall.
On August 27, Damore spoke with Hagland about the results, and shared his perspectives on what is working in moving accountable care/population health initiatives forward. Below are excerpts from their interview.
What have been your and your colleagues’ key learnings so far in the ACO venture?
The key question is, where do you invest your time in improving quality and lowering costs? That’s what we’re good at. We’ve worked with 65 ACOs that are MSSPs and Pioneers so far. And we’re really excited about it, because we think we’re doing some things that are really helping organizations. And if you talked to them, they’d tell you that. We provide a benchmarking tool for them, and a service we provide is that we’ll come in and do a gap assessment for them so they can focus on their efforts. We’ve done about a dozen of those, and the reaction, among a mix of Pioneer and MSSP ACOs, has been very positive. We identify the gaps.
What are the biggest gaps you’re finding?
In general, what we’re finding is that the organizations not making money have not made care management changes. We’re talking about managing high-risk patients, setting up a care management program for the 2-3 percent who make up 40 percent of the total expenses. And we use a hybrid model that includes clinical people and non-clinical people, so nurses, and also laypeople, who would be addressing issues like transportation, support systems for people, and there’s a high return on investment in using the care management, it’s very cost-effective.