It’s not often that progress comes in straight lines. To tackle complex problems, we test and innovate and then try out our new ideas, and then continuously reconsider, revise and adapt them over time. Few problems are more complex and vexing than figuring out how to make our health care system work for those it has been failing for so long: the most complex, high-risk, high-cost patients and their families.
So getting mixed results from the first year of testing Pioneer Accountable Care Organizations (ACOs) was to be expected. In fact, for those of us with experience working with our health care system and a dose of realism in our perspectives, it was all but inevitable.
But we see more potential good than bad, and reason for hope, in the outcomes the Centers for Medicare and Medicaid Services reported for the first year of this grand experiment.
All 32 of the Pioneer ACOs met the quality performance metrics. The 32 Pioneer ACOs performed well on cancer screenings, blood pressure control, cholesterol control for diabetes patients, and other indicators of quality care. Twenty-five of the 32 had success in reducing hospital readmission rates.
More than a third also succeeded, during just this first year, in reducing costs, producing cumulative savings of more than $87 million and saving Medicare nearly $33 million. For the 669,000 Medicare patients in the program, costs increased by just 0.3 percent over the course of the year – a much smaller increase than the 0.8 percent experienced by similar Medicare beneficiaries over the same period. Just two Pioneer ACOs lost money, and their losses totaled $4 million.
Nine of the 32 Pioneer ACOs are leaving the program, but the majority will continue. It is not surprising that some health care systems would re-evaluate their participation and choose to move on. The program does not guarantee that it will be the right fit for every health system. That’s the nature of innovation. And no model may be right for every population in every community. It is important, however, to examine these departures for the lessons they offer.
The imperative of patient- and family-centric care. We have said before, on this blog, that the real measure of success will be whether ACOs are able to provide better-coordinated, more patient-centered care for millions of patients and give us a way to get better value for our health care dollars. That may not happen, in all cases, in just one year.
We remain optimistic. ACOs represent one innovative model with the potential to improve care coordination, ideally leading to improved quality and lower costs. Testing of that model should continue, and we are pleased that the Medicare ACO program has given a boost to the development of ACOs, which are now proliferating among private health plans and provider groups.
But we are convinced that ACOs will only succeed over the long term if they genuinely engage patients, families and consumers, in a comprehensive way, in both their design and their implementation. Certainly nobody is better able to ensure that we are improving the care experience and care coordination, and reducing duplication and waste, than those who suffer when we fail to achieve those goals.
That is why we believe that ACOs should be accountable for high performance on patient- and family-centric measures such as patient-reported outcomes, care experience and care coordination. We believe that kind of accountability is key to success for ACOs.
We also believe that building a strong foundation of primary care will be key to the long-term success of ACOs. Good primary care is essential to the prevention, coordination and care management that produce better health outcomes, better care experience, more appropriate use of services, and lower costs.
A promising track, but patience is needed. In this country, we tend to look for magic bullets – perfect and permanent fixes. If a new approach doesn’t work immediately, we sometimes become disillusioned.
The ACO experiment deserves better. The nation has few higher priorities than to create a health care system that coordinates patient care, improves outcomes, and ends miserable patient experiences, duplication, waste, errors and skyrocketing costs that are crippling families, businesses and government. We think the Pioneer ACOs are on a promising track to realize better care and better value for our health care dollars. If these health systems increasingly become more patient- and family-centric, and strengthen their delivery of primary care, we will make progress.