×

Obamacare accountable care programs had $466 million in Medicare savings last year

Hospital
Dana Neely | Getty Images

Groups of hospitals, doctors and other health providers that agree to coordinate patient care as part of an Obamacare program generated $466 million in savings to the federal Medicare program in 2015, officials said Thursday.

The groups, known as accountable care organizations, provide care for a total of about 7.7 million beneficiaries of Medicare, the program that covers primarily senior citizens.

"Collectively, Medicare Accountable Care Organizations have generated more than $1.29 billion in total Medicare savings since 2012," the Centers for Medicare and Medicaid Services said Thursday.

If the ACOs provide better care through their coordination, as measured by a set of metrics, they can share in the cost savings they achieve for Medicare.

CMS said that for 2015, a total of 125 ACOs out of the 400 ACOs who generated the $466 million in savings to Medicare qualified for shared-savings payments.

A smaller subset of 12 Pioneer ACOs risk their own money in the program in the event they don't save Medicare any money. The number of Pioneer ACOs has shrunk from 32 over the past several years as groups have dropped out.

Of the eight Pioneer ACOs that generated savings for 2015, six earned shared savings because the savings were higher than a minimum threshold, CMS said.

Only one of the four Pioneers that generated losses owed shared loss because they exceeded a minimum loss rate.

"All 12 participants in the Pioneer Accountable Care Organization Model improved their quality scores from 2012 to 2015 by more than 21 percentage points," CMS said. "Overall quality scores for nine out of 12 Pioneer participants were more than 90 percent in 2015."

ACOs in the Medicare Shared Savings Program, which total 392, also continued to "show improvement," with ACOs that reported in both 2014 and 2015 improving on 84 percent of the quality measures that were reported in both years, CMS said.

The ACOs were created by the Affordable Care Act as part of a push by health officials to move to a system where health providers are paid more for the quality of the health outcomes achieved for patients, and less for the number of health services that they provide to those patients.

The so-called fee-for-service model in the U.S. health system has been blamed for boosting health-care costs in excess of the rate of overall inflation for decades.

Dr. Patrick Conway, CMS Principal Deputy Administrator and Chief Medical Office, said, "Accountable Care Organization initiatives in Medicare continue to grow and achieve positive results in providing better care and health outcomes while spending taxpayer dollars more wisely."

"CMS continues to work and partner with providers across the country to improve the way health care is delivered in the United States," Conway said.

Conway disclosed his mother is a patient covered by an ACO, and had received a call from a patient coordinator earlier in the day to arrange follow-up care.