The Medicare Shared Savings Program may generate only limited savings for participating accountable care organizations, according to a study in Health Affairs.
The authors simulated a Medicare type 2 diabetes population aged 65 to 75 and calculated the effects of improving performance on measures related to diabetes. Under the shared savings program, CMS will look at two diabetes-related measures to calculate shared savings:
1. A composite of hemoglobin A1c below 8 percent, low-density lipoprotein cholesterol below 100 mg/dL, blood pressure below 140/90 mmHg, tobacco nonuse and use of aspirin.
2. HbA1c below 8 percent.
In the simulation, across all measures, a 10 percentage point improvement in performance prevented up to 4.1 percent of adverse events, such as strokes, myocardial infarctions and microvascular complications. The prevented adverse events yielded up to 1.22 percent savings — below the 2 percent threshold CMS set for shared savings with providers.
When the authors accounted for the costs of visits and tests needed to achieve the improved performance, only the composite, blood pressure, aspirin and smoking measures generated savings, ranging from 0.02 percent to approximately 1 percent. When the costs for drugs were also taken into account, savings were achieved for only blood pressure and smoking cessation measures, at 0.11 percent and 0.78 percent, respectively.
ACOs would receive only 50 percent or 60 percent of these savings, depending on whether they are in the savings only or savings/losses ACO model.
The authors suggest the limited savings from improving clinical performance means ACOs will need to find savings in other areas, such as care management programs and health IT.
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Aurora Health Care Clinic Selected as Medicare Shared Savings ACO
The authors simulated a Medicare type 2 diabetes population aged 65 to 75 and calculated the effects of improving performance on measures related to diabetes. Under the shared savings program, CMS will look at two diabetes-related measures to calculate shared savings:
1. A composite of hemoglobin A1c below 8 percent, low-density lipoprotein cholesterol below 100 mg/dL, blood pressure below 140/90 mmHg, tobacco nonuse and use of aspirin.
2. HbA1c below 8 percent.
In the simulation, across all measures, a 10 percentage point improvement in performance prevented up to 4.1 percent of adverse events, such as strokes, myocardial infarctions and microvascular complications. The prevented adverse events yielded up to 1.22 percent savings — below the 2 percent threshold CMS set for shared savings with providers.
When the authors accounted for the costs of visits and tests needed to achieve the improved performance, only the composite, blood pressure, aspirin and smoking measures generated savings, ranging from 0.02 percent to approximately 1 percent. When the costs for drugs were also taken into account, savings were achieved for only blood pressure and smoking cessation measures, at 0.11 percent and 0.78 percent, respectively.
ACOs would receive only 50 percent or 60 percent of these savings, depending on whether they are in the savings only or savings/losses ACO model.
The authors suggest the limited savings from improving clinical performance means ACOs will need to find savings in other areas, such as care management programs and health IT.
More Articles on Medicare Shared Savings Program:
Managing the Transition to Value-Based Reimbursement: 8 Core Strategies to Mind the GapACO and Patient-Centered Medical Homes: How One Organization Is Diving Into Both Models
Aurora Health Care Clinic Selected as Medicare Shared Savings ACO