ACOs: Overview of Preliminary Evidence And Next Steps

Transcription

1 ACOs: Overview of Preliminary Evidence And Next Steps Mark McClellan, MD PhD January 12, 2015 The Engelberg Center for Health Care Reform at Brookings

2 Growth of ACOs Over Time: Medicare vs. Non- Medicare # of ACOs Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Medicare Non- Medicare Total

3 Growing (Preliminary) Evidence on ACOs Medicare ACOs Commercial ACOs Medicaid ACOs 7.8 million beneficiaries 405 MSSP ACOs 19 Pioneer ACOs million beneficiaries (Nearly 300 plans) Over 40 ACO contracts in 19 states First year results: Higher measured quality Approx. one-quarter beat cost benchmark 1-2% overall savings vs benchmarks Second year results: 11/23 Pioneers earned shared savings ~1% overall savings vs benchmarks Substantial improvement on quality measures Typically larger payment and benefit reforms than Medicare ACOs Early results (not consistently analyzed): Improvement in measured quality Variable reported savings, 2-12% Limited results so far, but promising impacts on quality of care

4 Number of MSSP ACOs in Each Overall Quality Performance PercenOle Number of ACOs Below 30th 30th 40th 50th 60th 70th 80th 90th

5 First Year Quality Performance Score (% Total Points) By OrganizaOon Type 90% 80% 70% 60% 50% 40% 30% Academic Medical Center (n=1) FQHC (n=1) Hospital- Led (n=6) Integrated Delivery System (n=71) Other (n=17) Physician- Hospital Physician- Led (n=113) OrganizaOon (n=11)

6 ACO Quality Performance Scores vs. Percent Savings 20.00% 15.00% Percent Savings RealNve to Financial Benchmark 10.00% 5.00% 0.00% % % % % Totla Quality Score (out of 1.0)

7 Big Issues for Accountable Care OrganizaOons Engaging and AcOvaOng Beneficiaries IdenOfying Best PracOces and Sustainable Pathway for Clinical TransformaOon Managing Startup Costs Bearing Financial Risk: Shared Savings, ParOal Risk, and Insurance Risk McClellan et al. Issue Brief: How to Improve the Medicare Accountable Care Organization (ACO) Program. The Brookings Institution, June 2014

8 Policy Issues for Accountable Care OrganizaOons OpOmal Payment Mechanisms and Pathways for SupporOng Care TransformaOons IncenOves and Support for Beneficiary Engagement Payment Formulas: Benchmarks for Quality and Cost Improving Data and Performance Measures Combining ACO Reforms with Other Payment Reforms McClellan et al. Issue Brief: How to Improve the Medicare Accountable Care Organization (ACO) Program. The Brookings Institution, June 2014

9 Major Topics in Medicare s Proposed ACO Rule Claims Data Sharing Criteria for Beneficiary Assignment to an ACO Shared Savings and Losses in Tracks 1 and 2 CreaOon of Track 3 for TransiOon to Risk- Sharing Waivers & Other IncenOves for ACOs to Assume Two- Sided Risk Establishing, UpdaOng, & Resefng Financial Benchmarks

10 CriOcal Issues in Medicare s Proposed ACO Rule Meaningful parocipaoon: How can CMS encourage parocipaoon while soll assuring meaningful reforms in care and savings in the program? Shih to shared risk: How can CMS promote the transioon to shared risk without discouraging parocipaoon or raising costs? Shih from fee- for- service regulaoons: How should regulaoons designed for fee- for- service payments be reduced, giving ACOs more flexibility without creaong the risks that the regulaoons were intended to address? Reduced uncertainty and easier path for ACOs to delivery reform: How can CMS ensure more certainty for program parocipants about how to improve care? CMS parocularly seeks comments on such key topics as: Proposals for revising performance and spending benchmarks Revised condioons for ACO tracks, parocularly new Track 3 and a transioon path to greater risk- bearing Beneficiary alestaoon for ACO parocipaoon

11 State- Based Accountable Care Arrangements ConOnue to Grow National Association of State Health Policy. State Accountable Care Activity Map.

12 ACO Learning Network Webinar series covering criocal policy updates, learning opportunioes from experts, and innovaoons in the field ImplementaNon- focused workgroups and affinity discussion groups that focus on pracocal next steps in key areas for accountable care success Member- driven conferences and meenngs to discuss and dissect pracocal accountable care implementaoon soluoons; ImplementaNon tools and research products In- depth member discussions around key issues and best pracoces for accountable care in all stages of development and implementaoon Member- specific website with implementaoon tools and research, real- Ome ACO tracking, archived content, news and resources Learn More hzp://