Accountable care organizations continue to improve the quality of care for Medicare beneficiaries while generating financial savings, according to 2015 quality and financial performance data released Thursday.

Alternative payment models such as ACOs are meant to improve quality and health outcomes while reducing the cost of care. Toward those ends, the Centers for Medicare and Medicaid Services announced that more than 400 Medicare ACOs generated in excess of $466 million in total program savings last year. That number includes 392 Medicare Shared Savings Program ACOs and 12 Pioneer ACOs.

Patrick Conway, MD
Patrick Conway, MD

CMS reported that overall quality scores for nine out of 12 Pioneer ACOs scored more than 90 percent in 2015. In addition, 125 Medicare ACOs qualified for shared savings payments last year by meeting quality performance standards and their savings threshold.

“The results show that more ACOs are sharing savings in 2015, compared to 2014, and that ACOs with more experience in the Pioneer ACO Model and the Medicare Shared Savings Program tend to perform better over time,” CMS reported.

Currently, there are more than 470 ACOs that serve 8.9 million Medicare beneficiaries. ACOs are “judged on their performance, as well as their improvement, on an array of meaningful metrics that assess the care they deliver,” including “how highly patients rated their doctor, how well clinicians communicated, whether patients are screened for high blood pressure and their use of electronic health records,” states the August 25 announcement from CMS.

Based on a comparison of 2014 and 2015 data, the agency concluded that average quality performance improved over that time by more than 15 percent on key preventive care measures, including screening for risk of future falls, depression screening and follow-up, blood pressure screening and follow-up, as well as providing pneumonia vaccinations.

In a press conference, Patrick Conway, MD, CMS acting principal deputy administrator and chief medical officer, said ACOs are part of the agency’s “broader strategy to improve the healthcare system by paying providers for what works, unlocking healthcare data, and finding new ways to coordinate and integrate care to improve quality.”

However, to unlock the value of healthcare data, these organizations need not only a strong health IT infrastructure but also the ability to exchange data. Although ACOs have made significant investments in HIT, according to survey results released in early 2016, they continue to struggle with interoperability challenges, making it difficult to integrate data from disparate clinical sources.

The survey of 68 Medicare and commercial ACOs by the eHealth Initiative and Premier Inc. found that while HIT enables them to collect the data they need to deliver quality care and improve operational efficiency, data integration represents one of the biggest barriers to their success.

In the survey, 79 percent of respondents indicated that obtaining data from outside the ACO network was seen as the most formidable challenge facing ACOs, with 64 percent reporting that data integration was a major hurdle to developing and operating their ACO.

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