ACO Growth Indicates Expanding Need For Evidence-Based Decision Support Tools
By Joe Guerriero, senior vice president of MDGuidelines, ReedGroup
If the National Association of Accountable Care Organizations (NAACOS) Fall Conference is any indication of the growth of the value-based care movement, then one fact is certain: it is not slowing down any time soon. The first NAACOS conference in 2012 had 123 attendees; 2016 had 670.
Although attendance has grown rapidly, the overall care quality and cost savings challenges and opportunities facing ACOs in this young, evolving market have not changed. Two presentations during the conference, in particular, drove these points home.
The Centers for Medicare and Medicaid Services (CMS) presentation showed some eye-opening slides about the growth of the number of ACOs participating in the Medicare Shared Savings Program (MSSP). For example, in the first performance year in 2013, there were 220 ACOs with nearly 3.7 million assigned Medicare beneficiaries. Just three years later in the 2016 performance year, there were 432 ACOs with nearly 7.8 million beneficiaries.
Another encouraging trend for ACOs is that participants’ ability to achieve the care-quality and cost-savings goals seems to improve over time, at least among MSSP organizations highlighted in the presentation. For ACOs who started in the program in April 2012, their raw quality score jumped from 63.77 in 2013 to 73.15 in 2015. In fact, across four quality measures for certain screenings and a vaccination, average performance improved by more than 15 percent just between 2014 and 2015.
Likewise, cost management and financial performance also seems to improve with time. Thirty-one percent of ACOs shared in the cost savings they generated in the program in 2015, while only 26 percent shared savings in the first performance year. Most recently, 120 out of 392 (31 percent) of MSSP ACOs generated savings above their minimum savings rate in 2015. All of those ACOs, except for one that missed the quality metrics, will share MSSP performance payments totaling more than $645 million, up from $341 million in 2014.
Targeted Clinical Interventions Essential
Later, the Commonwealth Fund offered insight on reasons why these ACOs and numerous other high-performing healthcare organizations are excelling in quality and cost management.
This presentation at NAACOS concentrated on the industry’s high-need, high-cost (HNHC) patients. The organization’s analysis found this group, which accounts for roughly 5 percent of the total U.S. population, accounts for nearly half (49 percent) of healthcare expenses. The Commonwealth Fund also explained effectively managing the health of these HNHC patients is typically associated with six factors, the top two being “targeted interventions towards patients most likely to benefit” and a “comprehensive assessment of patients’ needs.”
What we have discovered at ReedGroup is ACOs and other organizations focused on delivering value-based care need to offer their physicians and integrated care teams clinical decision support tools at the point-of-care. These tools and resources can help them conduct comprehensive assessments of patients’ needs and target interventions toward patients most likely to benefit.
These tools include clinically validated, evidence-based guidelines that can help physicians and patients set recovery expectations, which supports stronger engagement and a more rapid, cost-effective return to health. This can help the organization more easily achieve the cost-savings targets required from most ACO and other value-based payment programs.
Evidence-based guidelines should then be shared across the care continuum so physicians in the hospital, but also in outpatient facilities, can easily access and review recovery expectations as well as treatment plans. It is no surprise to us that the Commonwealth Fund also cited “strong health IT” as another of the six factors associated with better outcomes and cost savings among HNHC patients.
MACRA Heightens The Stakes
With the MACRA requirements looming in 2017, ACOs and other providers face even greater value-based payment and care quality challenges ahead. MACRA and its associated Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) programs heavily emphasize quality performance.
The APM program track, which will be most applicable to providers participating in an ACO or some other value-based payment program, awards an annual 5 percent lump-sum bonus based on the qualified providers’ Medicare payments. To earn that bonus, however, CMS requires providers to use a certified EHR and follow care quality guidelines similar to MIPS.
Despite these new value-based payment challenges, organizations already have examples they can follow. They can emulate the best practices of early adopters of these programs and implement evidence-based decision support tools at the point-of-care to give providers an advantage in this young, but fast-growing, market.
About The Author
Joe Guerriero is senior vice president of MDGuidelines at ReedGroup.