As the accountable care organization (ACO) phenomenon evolves forward, the question naturally arises: is there a “right” or “best” way to do accountable care?
The question has taken on a particular currency at the moment, as last month’s results regarding the ACO programs under the aegis of the Medicare program, the Medicare Shared Savings Program for ACOs (MSSP) and the Pioneer ACO program, turned out to be mixed in their results. So much so, in fact that senior officials at the Centers for Medicare & Medicaid Services (CMS) felt compelled to “spin” the numbers to make the results from the two programs sound better.
As I wrote in that blog, “CMS itself, in its announcement, completely avoided stating the core numbers and percentages of ACOs, both in the MSSP and the Pioneer Program, that failed to generate any savings at all (though fortunately, apparently, none of the ACOs in either program performed so poorly that they actually went into a category in which they cost CMS beyond the normal cost parameters of the Medicare program). As a result, the agency avoided stating the following: 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.”
And, I added, “On one level, I can empathize with senior CMS officials, because these results, particularly in the MSSP program, are not exactly spectacular. To state clearly that 45 percent of the ACOs participating in that program generated no savings for the program, would sound discouraging, of course. But the reality is that this kind of work is very difficult, and everyone knows that, particularly everyone involved in the two programs.”
And shortly after I wrote that, I was able to interview Joe Damore, vice president of population health, at the Charlotte-based Premier, Inc. As Damore told me on August 27, the ACOs involved in Premier’s ACO collaborative have surpassed the advances of the MSSP and Pioneer programs overall. So, for example, 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.
If you read my interview with Damore, what seems clear is that the members of the Premier ACO Collaborative, with the help of Premier managers like Damore, have focused strongly on care management for the highest-utilizing members in their populations, and further, have focused on “re-visioning post-acute care,” as he put it to me. And within the care management focus, the collaborative’s ACO members have focused on what he referred to as “the six main chronic diseases that are the cause of the bulk of healthcare costs in this country: asthma, diabetes, congestive heart failure, COPD [chronic obstructive pulmonary disease], hypertension, and chronic depression. Those are the chronic diseases to focus on,” he noted, and added that the Premier collaborative ACOs are especially intent on helping their top 2-3 percent of highest utilizers manage those chronic illnesses for themselves.
What’s more, the Premier ACO Collaborative’s members organizations are drilling down through layers of data, and pushing forward aggressively to marry their clinical and claims data and apply rigorous and robust analytics to those data sets. And they’re also focusing on optimizing end-of-life care.
All these efforts are clearly paying off, and thus, the results have turned out to be better, to date, than average, among both MSSP and Pioneer ACOs.
What are the lessons we can learn from all this? They are several. First, signing up for the MSSP program or the Pioneer program is just the first step on a long, sometimes very challenging, journey, and ACO leaders are quickly finding that out. Second, as the Premier ACO Collaborative’s staffers and member organizations are proving, population health management strategies are at the core of success with ACO development; and that includes population health risk stratification, intensive care management with a focus on the most chronically ill/highest utilizers; and those population health management programs have to focus on the highest-impact diseases, as well. And third, the challenges of marrying and working with claims and clinical data, must be engaged.