Analysis of the performance of Medicare accountable care organizations in 2014 suggests progress in the Pioneer ACO and Shared Savings Programs during the third performance year, but many organizations still struggle to actually share in the savings. And, quality scores increased modestly.

In 2014, there were 20 Pioneer ACOs and 333 Medicare Shared Savings ACOs. Of these 353 ACOs, 97 qualified for shared savings payments totaling more than $422 million for meeting quality and savings thresholds, representing 27 percent of participants.

Medicare ACOs incur substantial investments when joining a program, including establishing an information technology infrastructure to support population health management, care coordination, data analytics and other services to keep patients healthy.

Also See: ACO Best Practices for Shared Savings

Pioneer ACOs, which tend to be larger delivery systems, in 2014 assumed accountability for the treatment of 622,265 beneficiaries, up 2 percent from 2013. These ACOs generated total savings of $120 million in 2014, up 24 percent from the previous year. But only 15 of the 20 Pioneer ACOs generated savings and of these, 11 generated enough to earn shared savings with the 11 qualifying for a total of $82 million in shared savings payments.

“Of five Pioneer ACOs who generated losses, three generated losses outside a minimum loss rate and owned shared losses,” according to a statement from the Centers for Medicare and Medicaid Services. “These ACOs are paying CMS $9 million in shared losses.”

Mean quality scores of Pioneer ACOs hit 87.2 percent in 2014, up incrementally from 85.2 percent a year earlier. So far, the big jump in quality came between the first and second years, from a 71.8 percent quality score in 2012 to 85.2 in 2013.

In 2014, Pioneer ACOs overall improved in 28 of 33 quality measures with average improvement of 3.6 percent across all quality measures compared to a year earlier. The strongest improvements were found in medication reconciliation, screening for clinical depression and follow-up care, and qualifying for an electronic health record meaningful use incentive payment.

In the 2014 Medicare Shared Savings program, 92 of 333 participating ACOs met financial and quality performance requirements and shared in payments totaling $341 million, while savings to Medicare totaled $465 million.

In 2013, 58 shared savings ACOs met requirements and split $315 million, with Medicare getting $383 million. Another 89 ACOs met their benchmarks for reduced healthcare costs but did not meet a minimum savings threshold so they did not qualify for shared savings. ACOs with more experience, predominantly those that started in 2012, were most likely to generate shared savings. Medicare Shared Savings ACOs reporting in 2013 and 2014 improved on 27 of 33 quality measures.

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