ACOs: What Are the Early Results?

Laura Beerman, director, customer segment analysis, Decision Resources Group, presented a discussion that highlighted the early results of accountable care organizations (ACOs). She said that while the Pioneer ACOs created a large initial buzz, their cost savings has varied widely. For example, the best ACOs produced an estimated $147 million in savings, while other ACOs only saved about $20 per member per month. She also noted that 9 of the original Pioneer ACOs left the program in 2013, including those like Healthcare Partners in California, Presbyterian Health Services in New Mexico, and Healthcare Partners in Nevada.

Ms Beerman said that even the most successful ACOS like Brown & Toland are experiencing growing pains. She cited Andrew M. Snyder, MD, Brown & Toland’s Chief Medical Officer, as testament to the lows that come along with the highs.

“Commercial ACOs are not Medicare ACOs and they are not alike. That’s part of the trouble our industry is having. There are 14 different big payers and each one with different metrics and targets, but the PCPs don’t know,” Dr Snyder said. “On the PPO side, you’ve got less data and a 3-month lag, at best. PPO ACOs are already at a disadvantage. You can’t do the prospective work. They don’t have a very good attribution model. If you don’t know whose attributed to you, it’s hard to be proactive with them.”

She also remarked on how 3 payers—Cigna, Aetna, and UnitedHealthcare—have 3 uniquely different approaches to achieving results.

Cigna currently has 78 ACOS, but plans to expand that to 100 in 2014. They fund ACO case managers and focus on chronic patient care. Aetna has 35 ACOs, but no “cookie-cutter” approach to their strategy. In particular, they center on health information technology (HIT) and have implemented small pilots to transition Medicare Advantage programs to ACOs. UnitedHealthcare also has a big focus on HIT, but only has 11 ACOs.

Ms Beerman concluded her presentation with several ACO trends and predictions. This included describing “Mega ACOs” or “Super ACOs,” which are created when individual ACOs merge. There are also “Collaborative ACOs,” and those groups that utilize the ACO model, but don’t adopt the name. She says these mergers and acquisitions achieve the same results as individual ACOs by focusing on “population health management via a volume-to-value shift.”