Aided by Home Visits, Pioneer ACOs Bring Medicare Savings

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Karen Utterback By Karen Utterback 
Vice President, Strategy, McKesson
Pioneer ACOs Result in Medicare Savings

Two recent studies found that accountable care organizations (ACOs) save the U.S. health system and specifically, Medicare money. An article in the New England Journal of Medicine discussed the results of a study that compared Medicare spending for beneficiaries attributed to Pioneer ACOs with a control group. The study found a savings of 1.2% in the ACO group.

Commenting on the study, Austin Frakt, co-editor-in-chief of The Incidental Economist, said the authors used the strongest possible study methodology and performed a large number of strong sensitivity analyses and falsification tests. Frakt noted that even ACOs that had dropped out of the Pioneer program achieved savings.

A study by the Journal of the American Medical Association found a savings rate of 4% in 2012 and a rate of less than 1.5% in 2013. The study compared Pioneer ACO spending with spending in the traditional Medicare fee-for-service program.

Neither study looked specifically at the role of home care in lowering costs, but The Boston Globe recently reported on care being provided by the Pioneer ACO run by Beth Israel Deaconess. A Globe reporter described home visits by the nurse practitioner, to an 86-year-old in East Boston. The patient suffers from lung disease and congestive heart failure and was hospitalized for a month in late 2013 for edema.

The nurse practitioner is employed by Beth Israel Deaconess Care Organization and visits this particular patient at least once a month to check breathing, gait, oxygen levels and weight. “By seeing the person, I can intervene early,” the clinician told the Globe. “I may be able to avoid an emergency room visit.” On a visit this spring, the nurse practitioner noticed the patient’s weight had jumped four pounds and suspected fluid buildup. She asked the patient to increase her medication for a few days to reduce her fluid levels.

Of the 32 ACOs that began in the Pioneer program, 19 are still participating. Patrick Conway, acting principal deputy administrator at the Centers for Medicare & Medicaid Services, said some aspects of the Pioneer program are being incorporated into two new risk-sharing care models currently in development. Additional healthcare organizations are interested in both existing and new programs, he said.

Has your home health organization considered partnering with ACOs to provide home care services to at-risk patients? Learn how to take advantage of partnership opportunities in the e-book “Creating Opportunities in Today’s Home Care Regulatory Environment.”

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