A study recently published in the Journal of the American Medical Association (JAMA) supports the success of the concept of the accountable care organizations (ACOs).
Payment incentives implemented with a commercial ACO initiative in Massachusetts—Blue Cross Blue Shield’s Alternative Quality Contract (AQC)—were associated with lower spending for Medicare enrollees served by the provider groups participating in the AQC. These findings suggest that evaluations of ACO programs may need to consider the implications for other patient populations to assess their full clinical and economic benefits, according to a JAMA press release.
The study mined 2009 Medicare claims for nearly 4.3 million beneficiaries for spending and quality measures. Quality measures included 30-day hospital readmissions, as well as cholesterol and diabetes screenings and mammographies. Small physician groups and medium and large independent and hospital-based physician groups were the focus of the study.
The authors of the study found the larger hospital-based groups had higher spending 30-day readmission rates than the smaller groups. Large, independent groups spent less on each beneficiary and performed better on quality measures. This was especially true of groups where physician risk sharing was more common, the study said. Hospital groups with strong primary care orientations did better on readmission and diabetes and spent less per patient than their peers with less emphasis on primary care.
By definition, an ACO is a network of providers and facilities that provide coordinated care of at least 5,000 Medicare patients. The goal—a focus of the Affordable Care Act (more widely known as Obamacare)—is to limit unnecessary spending. To date, more than 428 ACOs serve 14 percent of patients.