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Over $384 Million Saved In Two Years; Pilot ACO model Spells Success

Department of Health and Human Services recently released an independent evaluation report that focused on the fact that the Affordable Care Act’s pilot project, an inventive payment model, was not just able to enhance the value and quality of modern health care in the past two years, but was also capable of generating substantial saving to Medicare.

Furthermore, according to the autonomous Office of the Actuary offering Medicare & Medicaid Services (CMS) in the Centers, the criteria of first ever expansion was met when the pioneer ACO Model saved over $384 million in just two years, ensuring superior value and quality of contemporary health care. This brings it down to about $300 for every single participating beneficiary per year on an average, without any compromise on high quality patient care.

When Secretary Sylvia Mathews Burwell determined that this expansion of Pioneer ACOs will not limit the benefits and coverage, but will simply improve or maintain the patient care, coupled with the Actuary’s certification that the expansion is capable of reducing net Medicare expenses, it all boiled down to one thing, HHS considering means to scale the innovative ACO Model into different Medicare programs that still lack it.

When asked about it, HHS Secretary Sylvia M. Burwell said, “This is a crucial milestone in our efforts to build a health care system that delivers better care, spends our health care dollars more wisely, and results in healthier people”. He continued to explain his stand saying, “The Affordable Care Act gave us powerful new tools to test better ways to improve patient care and keep communities healthier. The Pioneer ACO Model has demonstrated that patients can get high quality and coordinated care at the right time, and we can generate savings for Medicare and the health care system at large.”

The Pioneer ACO Model launched by CMS, being the first payment model of its kind, is highly capable of ensuring that the experienced healthcare and Medicare organizations have the accountability for cost and quality outcomes for their patients. The method is bound to drive hospitals and doctors to work in coordination to ensure better patient care and health, while maintaining quality performance standards, as they are not just entitled to share savings generated by the ACO model for Medicare, but are also required to the losses generated, if they fail to meet the standards.

The current figures of the total number of Medicare beneficiaries that the Pioneer ACO Model is said to be serving is over 600,000. It is believed that as compared to the Medicare Advantage or the fee-for-service plans, the Pioneer ACOs ensure:

  • More timely and better care and communication with their providers.
  • Reduced requirement of tests and procedures and lesser inpatient hospital services required.
  • Increased providers follow up visits after hospital discharge.

The last couple of years have seen a substantial increase in Medicare savings amounting to about $279.7 million in 2012 and $104.5 million in 2013. The present stats state that a total of $417 million in total program savings for Medicare has been generated to date acclaiming to the ACOs in the Medicare Shared Savings Program and the Pioneer ACO Model.

The principal deputy administrator of CMS, MD, Patrick Conway added, “This success demonstrates that CMS can design and test innovative payment and service delivery models that produce better outcomes for the Medicare program and beneficiaries”. According to him, “This gives CMS greater confidence in scaling elements of the model to benefit people across the nation, and we are working to determine the best strategies for embedding the lessons we have already learned from the Pioneer Model into permanent Medicare programs and our nation’s health system.”