Savings from Accountable Care Organizations Greater in Patients with Multiple Conditions

Medicare Accountable Care Organizations (ACOs) have achieved modest savings in care to patients, especially those with multiple conditions.

Researchers from the Dartmouth Institute analyzed the effects of 252 Medicare ACOs implemented from 2012 through 2013.

The findings, published in JAMA Internal Medicine, showed that ACOs saved approximately $136 per patient annually, while clinically vulnerable patients (treated for 3 or more conditions) saved $456 per patient annually.

Authors noted that the savings were partly due to decreased spend in hospital care and skilled nursing facility care.

“What we’re finding is that reductions in total spending associated with ACOs are modest, increase slightly over time, and demonstrate savings consistent with other evaluations of ACO impact,” said lead study author Carrie Colla, PhD.

For the study, researchers used 5 years of Medicare claims data from 2009 to 2013 to analyze the overall Medicare population. They also evaluated a subgroup of Medicare beneficiaries treated for 3 or more conditions, which accounts for 22% of the overall Medicare population.

In addition to the per patient annual savings in both cohorts, researchers found that overall, Medicare ACOs are associated with a 1.4% reduction in hospitalization, 1.4% reduction in acute care spending, 1.9% reduction in emergency department visits, and a 5% reduction in skilled nursing facility spending.

The reductions accounted for an estimated total savings of $592 million among clinically vulnerable beneficiaries within the first 1 to 2 years of the implementation of ACOs.

“With Medicare ACOs, the majority of the savings is concentrated on patients with complex medical needs, indicating that coordinated care is likely a factor in being able to more efficiently treat chronic illness,” Colla said.