News & Commentary

Patients Value ACO Experience

Finally, some good news for accountable care organizations (ACOs). Medicare beneficiaries being served by the two government-sponsored ACO projects report having better access to care and their medical records, and they also feel that their care is being better coordinated, according to a study in the New England Journal of Medicine.

This comes as health plans abandon the Pioneer ACO program. There were 32 participating plans at the start; now there are 19. Using a sort of global capitation model, ACOs take on risk for managing the care of patients, but the question has always been whether provider organizations have the capability to do this.

“The ACO program is just too complex — there are too many quality metrics to track, and the incentives aren’t strong enough,” Chas Roades, chief research officer at the Advisory Board consulting company, tells the Wall Street Journal.

The Pioneer Program and the Medicare Shared Savings Program serve about 5.6 million beneficiaries.

The NEJM study compares about 32,000 fee-for-service Medicare beneficiaries served by ACOs with about 250,000 beneficiaries served by other providers.

“As compared with local control groups of patients served by non-ACO providers, patients served by ACOs reported improvements in domains more easily affected by organizations (access to care and care coordination) but not in domains in which changes in physicians’ interpersonal skills may be required to achieve gains (interactions with physicians and physician ratings),” the study states.

“In addition, medically complex patients, who were more likely to be the focus of ACO efforts to control utilization and enhance quality, reported significantly better overall care after the start of ACO contracts.”

There are some important implications here, say researchers. “Enhanced experiences by patients may encourage their loyalty to ACOs, potentially addressing some of the care fragmentation and instability in beneficiary assignment that diminish incentives and rewards for ACOs,” the study states. “Moreover, should preliminary evidence of savings generated by ACOs be confirmed, our findings would indicate that ACOs may be able to achieve savings in ways that do not adversely affect patients’ experiences.”

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