Although responsible medical organizations have existed for more than a decade, their effectiveness in reducing health care costs is still a controversial issue, which has aroused fierce condemnation and defense from industry experts. A new study stirred the pot again.
The goal of ACO, namely Responsible entity The quality and cost of cross-environmental care is to push the healthcare system to value-based care. The ACO model combines incentives with cost reduction and improved care so that participating providers can share the savings gained.The Center for Medicare and Medicaid Services launched the first ACO payment model in 2012.
But a new study published in the journal Science Journal of General Internal Medicine Shows that ACO may not cut costs as expected. CMS’s ACO programs are roughly break-even-this means that these programs either lose money or save no more than a few percent.
In this study, the researchers compared the financial performance data of all four CMS ACO programs from 2005 to 2018.
“We are impressed by the consistency of the adverse ACO effects of all project changes,” the study author, Dr. James Kahn, professor of the Philip R. Lee Institute for Health Policy at the University of California, San Francisco, said in a report. Telephone interview. “It’s not’This version doesn’t work, but this version’-it’s’ACO doesn’t make a big difference every time.'”
Kahn and his co-study author Kip Sullivan, member of the Community Organization Advisory Board Minnesota Universal Healthcare, Calling for the end of the ACO model.
They wrote in the study: “ACO does not apply to medical insurance, nor does it apply to the wider healthcare system.”
They redoubled their efforts on this idea Commentary articles published on STAT News last week. Instead, they recommend relying on lessons learned from other countries that have adopted a single payer system and universal coverage.
But others in the industry oppose this view, the first is the National ACO Association.
“ACO will not go anywhere,” said David Pittman, the association’s senior policy adviser, in an email. “ACO enjoys bipartisan support and needs to reform payment methods to get us out of the system of financially rewarding quantity-based care. ACO and value-based care have nowhere to go. In fact, they are needed now more than ever. “
Pittman questioned the conclusions and methods of this study.
He said that the study does not include the latest data — the study stopped in 2018 — which was the most successful year for ACO.
Just last week, CMS announced that participating in the 2020 Medicare Shared Savings Plan ACO has saved nearly $2.3 billion in total, while saving about $1.9 billion for medical insurance. This is the fourth consecutive year that medical insurance has achieved net savings. CMS stated in the press release.
When asked why data other than the data available in 2018 were not included, Kahn referred to an article by a professor at Harvard Medical School and the University of Southern California.
The article shows that “despite selection and churn biases, there was very little net savings in 2019,” Kahn said. “We could have spent a little more time, but this will not change the results of the investigation.”
Selection bias means that ACOs enter the CMS plan only when they are confident in their ability to generate savings faster, while attrition bias means that ACOs who fail to achieve savings have a higher exit rate.
Dr. J. Michael McWilliams, Professor of Health Care Policy, Warren Alpert Foundation, Harvard Medical School Who co-authored this article Kahn mentioned, Disagree with his conclusion that the ACO model should be dismantled.
Although savings are indeed small and the motivation to save is weak, the answer is not to completely end the ACO model.
“A more effective policy strategy is to improve the design of models to build on early progress, rather than abandon them based on superficial considerations of success so far,” McWilliams said in an email.
The second part of his article co-authored with Dr. Alice Chen, associate professor of public policy at the USC Price School of Public Policy, discusses in depth strategies for improving the ACO model implemented by CMS.
Like Pittman of NAACOS, McWilliams found that the research of Kahn and Sullivan was lacking.
“Research in [Journal of General Internal Medicine] Not rigorous,” he said. “This is a review article disguised as research. “
Dr. John Hsu, Director of the Clinical Economics and Policy Analysis Program at the Mongan Health Policy Institute of Massachusetts General Hospital, responded to McWilliams’ criticism.
“The impact of the ACO program on expenditures depends to a large extent on the nature and magnitude of the incentives adopted,” Xu said in an email. “So far, these incentives have been moderate and generous, partly because provider organizations will withdraw from the voluntary ACO program if they start to lose money or believe that the program’s incentives have created a heavy system.”
Although Hsu believes that it is valuable to summarize available estimates of the impact of ACO, which is exactly what Kahn and Sullivan’s research attempted to do, he questioned their conclusions about what these estimates mean for the ACO program.
“The ACO program is trying to change the nursing service by changing the incentive system,” he said. “By definition, this type of policy change takes time to have an impact because it is indirect in nature.”
It’s important to note that Hsu’s employer-the parents of the Massachusetts General Hospital-Mass General Brigham- Operate two ACOs. Although Volkswagen General Brigham Medical Insurance ACO Savings generated in 2019, In the first year of participating in the Medicare Shared Savings Plan, the health system spokesperson was unable to provide data showing that the second ACO, called the Mass General Brigham MassHealth ACO, also saved money.
Although there is no conclusive evidence on the efficacy of ACO, CMS is continuing to experiment with the model. May, CMS Announcing its next-generation ACO model It will end on December 31. This model enables participants to assume a higher level of financial risk and return than the medical insurance shared savings plan.
Instead, the agency will allow next-generation model participants to apply Global professional direct contracting model, A set of two voluntary risk-sharing options, like the ACO model, aims to reduce expenditures and improve the quality of care.
Regardless of the future of ACO, it is safe to say that patching different models to achieve the overall goal of improving care and reducing costs will continue.
Photo: Dutko, Getty Images
