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Medicare Accountable Care Organizations

The Centers for Medicare and Medicaid Services released the 2015 quality and financial performance results for Medicare Accountable Care Organizations (ACO) on August 25, 2016. The Medicare ACO program, which is a product of the Affordable Care Act (ACA), is a network of healthcare professionals who agree to be responsible for the cost and quality of care offered to the Medicare patients.

ACOs are aimed to offer greater collaboration across the divided healthcare system to make use of care coordination as a tool to decrease costs and to improve the quality of care. As per the program, ACOs can earn bonus points for outstanding performance in cost sharing and quality, but can also suffer financial losses if the performance is poor. The 2015 data, that is released now, is for the Pioneer ACO program and the Medicare Shared Savings Program (MSSP).

The Pioneer ACO program is the aggressive out of the two types of ACO programs. The program offers more potential savings and also has more potential for losses, while the Shared Savings Program can prove to be less risky. It is reported that CMS has also started to test a more aggressive version of the ACO program, called as the Next Generation (Next Gen) ACO.

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Medicare Shared Savings Program

Statistics shows that about 7.7 million Medicare beneficiaries have most or all of their care offered by a physician/hospital group that is participating in an ACO program. Out of the beneficiaries, about 460,000 are involved via Pioneer ACOs. The performance results show that over 400 Medicare ACOs made 466 million dollars in program savings for the year 2015, which is a big increase from the 411 million dollars savings in 2014. Of all, the ACOs that achieved savings, 125 qualified for bonuses.

Even though the data showed less participants in Pioneer ACO model when compared to the last year, there was big improvements in average quality performance score for the participants who remained under the model. CMS also reported a small increase in the percentage of participants who proved eligible for a bonus and the quality of care provided by them.