Inspector General of HHS Praises Strategies Used by ACOs to Shift to Value-Based Care

CMS should support the efforts that accountable care organizations (ACOs) are making to cut unnecessary costs and improve the quality of care.

That’s according to a new report from HHS’ Office of the Inspector General (OIG), which this week issued a 44-page report based on a sample of 20 high-performing ACOs. The report details the successful strategies that ACOs are using to work with physicians, engage beneficiaries to improve their own health, manage patients with costly or complex care needs, reduce avoidable hospitalizations and improve hospital care, control costs and improve quality in skilled nursing and home healthcare, address behavioral health needs and social determinants of health, and use technology to increase information sharing among providers.

ACOs also described how they have managed to address and overcome challenges in each of these areas.

In its continued effort to focus on paying for value rather than the volume of healthcare services, CMS last year revamped how ACOs participate in the Medicare Shared Savings Program (MSSP) by reducing the amount of time an ACO can stay in a 1-sided risk arrangement to 2 years. The MSSP is one of the largest alternative payment models that are part of the push to value-based care. Last year, CMS renamed the program “Pathways to Success.”

The report was praised by the National Association of ACOs (NAACOS), which said that it can take as long as 4 years before ACOs achieve savings. “Achieving success is an iterative process that takes time learning what works and what’s needed within an organization and community and is made harder by the lack of a ‘one-size-fits-all’ strategy,” Clif Gaus, ScD, president and chief executive officer of the organization, said in a statement.

NAACOS called the report “a roadmap for success in accountable care that should be read by policymakers and ACOs alike.”

“As CMS carries out this and other ACO programs and develops new alternative payment models, it should support the use of these strategies and other successful strategies that emerge,” the report said. “These strategies can apply not only to ACOs but also to other providers committed to transforming the healthcare system toward value.”

CMS, saying it concurred with the 7 recommendations made by OIG, said it is already taking steps to implement the changes.

The recommendations from the OIS say CMS should:

• Review the impact of programmatic changes on ACOs’ ability to promote value-based care
• Expand efforts to share information about strategies that reduce spending and improve quality among ACOs and more widely with the public
• Adopt outcome-based measures and better align measures across programs
• Assess and share information about ACOs’ use of the skilled nursing facility 3-day rule waiver and apply these results when making changes to the Shared Savings Program or other programs
• Identify and share information about strategies that integrate physical and behavioral health services and address social determinants of health
• Identify and share information about strategies that encourage patients to share behavioral health data
• Prioritize ACO referrals of potential fraud, waste, and abuse

Medicare spending is expected to exceed $1.5 trillion by 2028, more than double the $708 billion in spending in 2017.