Wednesday, July 17, 2013

Fwd: qotd: Pioneer Accountable Care Organizations disappoint

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-------- Original Message --------
Subject: qotd: Pioneer Accountable Care Organizations disappoint
Date: Wed, 17 Jul 2013 08:41:14 -0700
From: Don McCanne <>
To: Quote-of-the-Day <>

Centers for Medicare and Medicaid Services
July 16, 2013
Pioneer Accountable Care Organizations succeed in improving care,
lowering costs

Today, the Centers for Medicare & Medicaid Services (CMS) announced
positive and promising results from the first performance year of the
Pioneer Accountable Care Organization (ACO) Model, including both higher
quality care and lower Medicare expenditures. Made possible by the
Affordable Care Act, the Pioneer ACO Model encourages providers and
caregivers to deliver more coordinated care for Medicare beneficiaries.
This model, launched by the CMS Innovation Center, is part of the
Affordable Care Act's efforts to realign payment incentives, promoting
high quality, efficient care for Medicare beneficiaries. ACOs,
including the Pioneer ACO Model and the Medicare Shared Savings Program,
are one way CMS is providing options to providers looking to better
coordinate care for patients and use health care dollars more wisely.

"These results show that successful Pioneer ACOs have reduced costs for
Medicare and improved the quality of care for their patients," said CMS
Administrator Marilyn Tavenner. "The Affordable Care Act has given us a
wide range of tools to realign payment incentives in Medicare and
Medicaid, and these efforts are already paying off."


Bloomberg Businessweek
July 16, 2013
A Pillar of Obamacare's Cost-Saving Effort Falls Short
By Devin Leonard

It's no secret that the Obama administration's effort to roll out
health-insurance exchanges in every state is turning out to be more
challenging than expected. Its campaign to lower health costs isn't
faring any better. On Tuesday, the Centers for Medicare and Medicare
Services announced middling first-year results for the administration's
highest profile cost-control effort: the Pioneer Accountable Care
Organization Model.

Obamacare supporters have long promised that Accountable Care
Organizations — groups of hospitals and doctors that tend to large
flocks of Medicare patients, with an eye toward keeping them out of the
hospital — would be integral to bringing down the nation's health-care
costs. ACOs are supposed to come up with innovative ways of keeping
patients in better shape by focusing on preventive measures while saving
money in the process. Under the plan, the ACOs themselves are to be
rewarded with the share of the savings they generate.

Thirty-two health care provider groups signed up for the pioneer program
intended to promote the new model, but the Centers for Medicare and
Medicare Services said Tuesday that only 13 of them generated enough
savings to qualify for a cut. Two participants actually lost money instead.

The news wasn't all bad. The pioneers produced better-than-average
results on cholesterol control for diabetes patients. "Overall, we are
very excited about the results," Patrick Conway, chief medical officer
for the Centers for Medicare and Medicare Services, told the Wall Street
Journal. But a significant percentage of the pioneers weren't so
thrilled, and nine are slated to exit the program.

It's much too soon to call the pioneer program a failure. It's also
premature to say the ACO model is one that will save vast amounts sums
of money. That hasn't stopped some of the law's staunchest supporters,
who might want to temper their rhetoric after Tuesday's report.


Health Affairs Blog
July 17, 2013
Pioneer ACOs Year One: On The Path To A Learning Health Care System
By Douglas Hastings

The Pioneer Model should be seen as part of a crucial phase of testing
alternative payment and delivery models in an effort to achieve greater
value in health care. One year's results should not be seen as a
definitive outcome or leading to a dispositive conclusion, but rather as
a valuable source for learning.

The participating providers are required to be both financially and
clinically integrated. The ACOs must, among other core attributes, have
an effective governance and leadership structure, have the ability to
apply evidence-based medicine and care coordination processes, meet
quality measures, have a savings distribution formula, develop a robust
electronic health record infrastructure, and, importantly, be able to
effectively engage patients in their care and their health.

ACO skeptics clearly remain. Among the doubts and cautions that have
been raised are that ACOs will drive insufficient change in physician
behavior and patient engagement, result in insufficient savings, create
a specialist (and thus patient) backlash, suffer from lack of agreement
over measures and metrics, and drive up prices due to consolidation.
These are legitimate concerns. But such concerns should not mean that
the testing should slow down. Rather, in my view, it should accelerate,
given some early positive results and the ongoing cost and quality
challenges faced by our health care system.

Comment: The Pioneer Accountable Care Organizations (ACOs) were already
existing health care organizations that were selected as potentially
exemplary models that could show the rest of the nation how well ACOs
can work to achieve higher quality at lower costs. We now have a report
from CMS of the initial "successes" of this model. Although the rhetoric
from CMS is quite rosy, most reporters were not impressed, as the
Bloomberg Businessweek response demonstrates.

Considering the added administrative hassle, the savings were
negligible, with only 13 of the 32 organizations saving enough to
receive "shared savings" from CMS, and 2 actually lost money.

Even the supposed quality gains were unimpressive since they represented
only 15 measurements which the organizations were told in advance would
be used to determine whether or not they met quality standards. These
teach-to-the-test gains can hardly represent the overall quality status
of each organization.

It is time for our policy makers to stop wishing that the ACO model is
the nirvana of health policy and get on with endorsing a proven model of
enhancing quality while controlling costs - a single payer national
health program - a model that would have the additional benefit of
actually covering everyone.

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