CMS Releases Medicare ACO Results for 2014

The Centers for Medicare and Medicaid Services (CMS) yesterday released 2014 quality and financial performance results for Medicare Accountable Care Organizations (ACOs). The results for the 353 Medicare Pioneer model and Shared Savings Program (MSSP) ACOs nationwide were mixed.   Participants in these programs agree to meet targets for quality and slow health care spending; those that succeed can keep a share of money they save. The report shows 97 of the 353  ACOs nationally earned bonuses totaling $422 million out of $833 million in savings they produced.

North Carolina has 13 MSSP ACOs based in or with service areas in North Carolina that reported 2014 performance data. Seven additional MSSP ACOs  launched this year in the state, but were not part of this report.

Of the group reporting 2014 data, two organizations – CaroMont ACO in Gastonia and Cornerstone Health Care in High Point – earned a shared savings check. Two other ACOs in the state did achieve shared savings above the minimum savings rate, but did not receive a check because of failure to meet the quality reporting requirements. Six more successfully reported on quality metrics and saved money but did not exceed their minimum savings rate: WakeMed Key Community Care in the Triangle, Physicians Healthcare Collaborative, the Wilmington Health ACO in Wilmington, Coastal Carolina Health Care in New Bern, Triad HealthCare Network in Greensboro and Carolinas ACO, which serves patients in both North and South Carolina.

Cornerstone’s quality ratings were the highest in the state at 94 percent — sixth in the nation of the comparable 214 ACOs reporting for the same period. In the state, Coastal Carolina’s quality ratings were at 91 percent and Wilmington Health’s at 90 percent.

“We respect the big challenge taken up by the North Carolina doctors working in these ACOs,” said Robert E. Schaaf, MD, FACR, president of the North Carolina Medical Society (NCMS). “They are striving day in and day out to deliver on a bold commitment — the best quality health care in the most efficient manner that medical science has to offer. We will continue to support our doctors in this work.”

Other takeaways from the report include that ACOs tend to improve over time: 37 percent of the MSSP ACOs launched in 2012 generated shared savings compared to 27 percent that began in 2013 and 19 percent from 2014.

MSSP ACOs also improved on quality compared to 2013. ACOs reporting the last two years showed improvement in 27 out of the 33 quality measures, particularly in clinician-patient communication, patient ratings of physicians, tobacco screening, blood pressure screening and EHR use.

Get more detail on the results.

The program is still receiving strong interest and CMS plans to announce new and renewing ACOs by the end of the year.

All eyes are on the performance of this model of care to help curb health care spending through better care coordination and population health management.

CMS Acting Administrator Andy Slavitt said in a CMS press release on the results: “These results show that accountable care organizations as a group are on the path towards transforming how care is provided. Many of these ACOs are demonstrating that they can deliver a higher level of coordinated care that leads to healthier people and smarter spending.”

Some took a less positive tone, like the National Association of ACOs, which issued a press release stating: “While the number of ACOs with positive results and the total dollar savings have increased due to the additional 100+ ACOs that were added to the program, the average savings per ACO actually declined by a significant percent.” The organization’s CEO, Clif Gaus, added: “Savings per ACO decreased. This is probably due to the unfair quality penalty which is so stringent that unless an ACO scores perfectly on every quality measure, their savings will be reduced. We expect ACOs to deliver better care for Medicare beneficiaries but the quality benchmark that CMS prescribes is the government example of letting the perfect be the enemy of the good.”

CMS has pursued improvements to the program over the last year finalizing a new rule in June that made significant changes to the program requirements, including allowing for an additional 3-year contract term with no downside risk for current ACO participants, and maintaining the 50 percent sharing rate for those who choose this option among other updates. Read more about the updated rule.



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  • James

    The quality information you all list is misleading… Cornerstone earned the highest overall percent of Quality Points in North Carolina compared to other ACOs in the state who were past Performance Year 1. Majority of the ACOs in NC were in their first performance year and therefore earn 100% of the possible Quality Points available.

    Also, the percent of Quality Points earned does not indicate the “highest quality” ratings overall. CMS SSP ACOs in Performance Year 2 and Performance Year 3 have different measures that are considered “Pay for Performance”.

    Cornerstone earned the 5th highest percent of Quality Points for ACOs that started in 2012 (n=111). Cornerstone earned the 6th highest percent of Quality Points for ACOs who were past PY1; 2012 and 2013 starters (n=214).

  • Achieving success as an ACO requires multiple assets including physician leadership, health team commitment, great administrative leadership, top notch informatics, patience, ability to tolerate risk, and capacity to learn the intricacies of a complex system. Savings is very difficult to achieve without a plan and commitment. However, ACOs are saving money and the federal government is the biggest beneficiary. griff