Former CMS head talks accountable care ROI


Accountable care organizations continue to gain momentum, delivering on promises of high-quality care at a lower cost.

Both payers and providers can reap financial returns from ACO efforts, former Centers for Medicare & Medicaid Services Administrator and current Director of the Health Care Innovation and Value Initiative at the Brookings Institution Mark McClellan, M.D., Ph.D., told AAFP News in an interview.

McClellan made clear that slow and steady wins the ACO race. Some ACOs may gain traction more quickly than others--Humana, for example, already has married providers' clinical expertise with the insurer's business views to ensure success--while other ACOs that include diabetes management could take much longer for improvement in care to translate into savings.

From the physician point of view, a practice must assume the overall financial risk of its patients to transition away from fee for service to an ACO model, McClellan explained. Practices should approach their care differently by increasing their physician or nursing staff to avoid possible readmissions and ultimately help lower costs. 

McClellan's take on ACOs is on point with former White House healthcare adviser, Ezekiel Emanuel, who said earlier this year that ACOs must compete to provide care at lower prices while referring patients to high-quality facilities for chronic conditions, like cancer, FierceHealthPayer previously reported.

"In general, the ACOs are doing pretty well in terms of quality of care and improving on important quality measures. Financially, about half of the 114 ACOs participating in the Medicare Shared Savings Program reported that they reduced Medicare spending in their first year of operation," McClellan stated.

And as more ACOs experience success, the new payment and delivery model will appear more attractive as plans make larger shifts from FFS, he noted.

For more:
- here's the full interview

Related Articles:
Payer-led ACOs find early success
ACOs will replace insurers, former Obama adviser says
3 signs ACOs will continue to thrive
ACO success requires data integration
Medical home must-dos for population health management