Savings Alone Shouldn't Determine ACO Success

Formed on the tenets of coordinating care for better patient outcomes and reduced costs, accountable care organizations (ACOs) haven't necessarily lived up to their mission straight out of the gate. But that doesn't mean they aren't helping patients and changing healthcare delivery, according to two executives leading this practice model.

In recent data released by CMS on its Pioneer ACOs, only a quarter of participating programs achieved reduced healthcare costs while only 60 percent of those who started in the program remain.

"I think the popular media likes to say that only 25 percent of ACOs were 'successful,' but how can you judge ACOs on the first year of results?" asked David Cook, chief administrative officer for Milwaukee-based ProHealth Solutions, a participant in the Medicare Shared Savings Program (MSSP) since 2012. "We've improved quality … so I'd say we were successful on contracting and what we've done in the marketplace. … Going forward, the intent will be to make money, but that's too limited a viewpoint on what success means."

Cook, along with Stephen W. Nuckolls, CEO of North Carolina-based Coastal Carolina Health Care, presented "Sharing the Medicare ACO Experience" at the 2014 Medical Group Management Association Annual Conference on Tues., Oct. 28.

At ProHealth Solutions, 443 physicians (34 percent primary care and 66 percent specialists) work under the ACO model with Medicare and 19 other payers, including commercial insurers. This is proof, Cook said, that "the market sees value in contracting with us … and that these payers recognize our clinical integration program."

"They see the value in contracting with ACOs versus each physician individually," he said. "This proves that out in the open market, that value-based purchasing can work."

Some components that help ProHealth Solutions succeed, Cook noted, are working under a common EHR along with a data warehouse to have uniform patient records as well as the use of "health coaches," six RNs who've completed advanced training and work with physicians to provide individual coaching to 200 Medicare patients with chronic diseases.

At Coastal Carolina Health Care, more than 50 providers (60 percent primary care) work in 11 locations as their ACO structure.  Like ProHealth Solutions, they joined the MSSP in 2012 for some simple reasons, said Nuckolls.

"We had the belief that healthcare was moving from rewarding for volume to value … and aligning incentives to reward [physicians] for keeping patients healthy was the right thing to do," he said.

While the ACO has seen small gains in savings, its quality measures have really excelled, said Nuckolls, pointing to marked improvements in colorectal cancer and mammography screening, as well as reducing readmissions. So while one of the goals is being achieved, there is hope the second will follow.

"I think there is a lot of reason for optimism," he said. "Even if the model has flaws, it's moving in the right direction. When you reward for better care … you reward the right behaviors. Even if [in the future] ACOs are not in this form, it will be something similar."