Bending the Spending Curve: The Role of Care Management in a Pioneer ACO

Paper
Key Questions Answered
  • What explains the lower medical spending associated with Accountable Care Organizations (ACOs)?
  • What is a promising strategy for selecting participants for a care management program?
Key Themes and Takeaways

This resource examines the impact of participation in a Pioneer ACO and its care management program on emergency department (ED) visits, hospitalizations, and Medicare spending.

 

  • The care management program was the ACO’s primary strategy for achieving its cost and quality goals under the Pioneer ACO program.
  • The program targeted participants who, based on information from their primary care physicians, were at elevated risk for future spending but whose risk appeared to be modifiable.
  • For participants, rates of ED visits were reduced by 6 percent, hospitalizations were reduced by 8 percent, and Medicare spending was reduced by 6 percent.
  • Targeting beneficiaries with modifiable high risks and shifting care away from the ED represent viable mechanisms for altering spending within ACOs.
Authors
John Hsu
Population Addressed
Adults Under 65 with Disabilities
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Level of Evidence
Promising Evidence
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