Testing the waters in the Medicare Shared Savings Program may cost participants $1 million or more in capital and operating expenses, and only a handful have really performed well, according to a whitepaper from Salt Lake City-based Leavitt Partners.
While there is certainly room for improvement, an analysis of accountable care organization results shows reason for optimism, according to the Leavitt Partners analysis. The whitepaper identifies 10 trends based on public and proprietary data that help illustrate what has worked and what has not in the MSSP thus far. Here are the 10 findings in brief.
1. Physician-led ACOs tend to fare better than hospital-only ACOs. One in three ACOs managed by physician groups earned shared savings, while only about one in five ACOs managed by hospital systems alone earned shared savings. Those managed by both physician groups and hospitals landed in the middle. Hospital-only ACOs also earned the lowest average quality scores, according to Leavitt Partners. The best quality scores were earned by ACOs managed by both physician groups and hospitals.
2. Shared savings are highly concentrated among a few ACOs. The top 10 ACOs for shared savings earned 30 percent of all shared savings awarded to all MSSP ACOs, and the top 10 percent of MSSP organizations earned 64 percent of all earned savings. As the report notes, "While some ACOs are performing meaningfully well, most are not."
3. Experience pays off. ACOs that have participated in the program longer earn greater shared savings over time. Roughly 35 percent of those ACOs that entered in the first round earned shared savings, compared to 19 percent who entered in Round 4, indicating the organizations are improving over time.
4. Findings suggest it may be easier for smaller ACOs to manage costs, though no proven causal relationship exists.Leavitt Partners found ACOs that covered more patients did not earn more shared savings. The larger ACOs did earn greater quality scores, but these scores did not translate to greater financial gain.
5. Higher-cost markets are associated with greater shared savings. When ACOs are divided into five quintiles from highest to lowest Medicare costs, data shows those in the higher-cost markets with greater levels of healthcare utilization are more likely to earn shared savings. Among the 20 percent of ACOs with the highest Medicare costs, 42 percent earned shared savings, compared to just 18 percent of those from the quintile with the lowest Medicare costs, according to Leavitt Parnters. On top of that, the greatest shared savings were awarded to ACOs in the highest cost markets.
6. Top shared savings were associated with high quality scores and Medicare cost benchmarks. According to Leavitt Partners, this indicates market costs cannot entirely explain financial success.
7. Though the top earners had higher average quality scores, this relationship didn't hold when reversed. In other words, high quality did not necessarily predict higher shared savings.
8. More than a third of quality losses stemmed from three metrics. These metrics were heart failure admissions, percent of primary care providers who qualified for EMR incentive payment and chronic obstructive pulmonary disorder/asthma-related admissions.
9. There is a positive correlation between the number of contracts an ACO has and quality scores. It did not find a correlation between contracts and savings. However, the report notes, "It is hard to infer too much from these results and make any definitive judgments given it will take significant effort, time and commitment to drive meaningful organizational changes. Just because one entity forms multiple contracts, whether simultaneously or in close proximity, does not mean quality and savings improvements will occur overnight."
10. Geography matters. Generally, ACOs in what is generally considered the Southeastern part of the U.S. earned the most in shared savings in 2014. Leavitt Partners named these areas as East and West South Central regions (Alabama, Kentucky, Mississippi, Tennessee, Arkansas, Louisiana, Oklahoma and Texas). Those in the Midwest generally earned the highest quality scores in 2014. Leavitt Partners characterizes these regions as the East and West North Central divisions (Illinois, Indiana, Ohio, Wisconsin, Michigan, Iowa, Kansas, North Dakota, Nebraska, Minnesota, Missouri and South Dakota).
For more details on MSSP performance, read the full report here.
More articles on accountable care:
8 accountable care, shared savings agreements in March
Louisiana physicians earn $3.4M in value-based incentives for improving Medicaid outcomes
22 organizations call for changes to ACO benchmarking rule, MSSP inclusion in MACRA