The Medicare Shared Savings Program, one of Medicare's largest value-based care demonstrations, proved to be fairly successful over time in reducing spending and improving the quality of care, according to a report from HHS' Office of Inspector General.
"While policy changes may be warranted, ACOs show promise in reducing spending and improving quality," the report reads. The report analyzes the performance of the program's 428 ACOs that participated in the program in its first three years, from 2013 to 2015.
Here are the OIG's main findings.
1. Across all ACOs, the program's net reduction in Medicare spending was nearly $1 billion, compared to benchmarks. Two-thirds of the ACOs reduced spending in at least one year of the program, totaling a $3.4 billion reduction. Almost half of this was concentrated among 36 ACOs, which generated $1.7 billion of that savings. However, the 146 ACOs that exceeded benchmark spending did so significantly. They exceeded benchmarks by $2.4 billion, offsetting roughly two-thirds of the savings generated among the other ACOs.
2. ACOs improved over time. ACOs in the program for all three years were more likely to reduce spending in 2015 compared to those in the program for just one year (57 percent compared to 46 percent). The more experienced ACOs also generated greater savings — an average of $10.1 million per ACO in 2015, compared to $5.4 million per ACO among the newer ACOs.
3. Overall quality improved across the program. The average overall quality score improved from 86 in 2014 to 91 in 2015. Performance improved across 82 percent of the measures and ACOs outperformed fee-for-service providers across 81 percent of the quality measures. Notable improvements were made in depression screening, fall risk screening and hospital readmissions. However, a handful of measures worsened, such as timely access to care and high blood pressure screening and follow up.
4. The highest performers — those able to reduce average spending per beneficiary on certain services by an average of $673 from 2010-2015 while improving quality — were similar in several ways. Spending was compared from 2010-2015 to see how ACOs changed since joining the program. The highest performing ACOs participated in the program all three years, had slightly larger and sicker patient populations, used more primary care and reduced inpatient care and skilled nursing facility care.
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