FROM JAMA INTERNAL MEDICINE

In its first year, the Medicare Pioneer accountable care organization (ACO) program resulted in modest reductions in low-value medical services that provide minimal clinical benefit to patients, according to a study published Sept. 21 in JAMA Internal Medicine ( doi:10.1001/jamainternmed.2015.4525 ).

The Pioneer ACO model was associated with a differential reduction of 0.8 in low-value services per 100 beneficiaries or a 1.9% decrease in service quantity, and a 4.5% reduction in spending on low-value services.

Lead author Aaron L. Schwartz, Ph.D., of Harvard Medical School, Boston, and his colleagues compared the use of low-value services by Medicare fee-for-service patients whose providers were in the Pioneer ACO program with use of low-value services by beneficiaries of other health care providers. They examined services from 2009 to 2012 using Medicare claims for a random 20% sample of patients. Comparisons were adjusted for sociodemographic and clinical characteristics and for geography. Low-value services were defined as care providing minimal or no average clinical benefit in specific clinical scenarios.

The greatest reductions in service occurred for the most frequent services, including cancer screening and imaging. Cardiovascular testing and procedures underwent the greatest differential reduction – a 6.3% decrease in low-value services for the Pioneer ACO group. ACOs that were providing more low-value care on average experienced greater reductions.

The study findings are consistent with other conclusions that Pioneer ACO models improve the overall value of health care provided, Dr. Schwartz noted. The findings also demonstrate that patient care preferences may not be major obstacles to reducing low-value service use.

The Medicare Pioneer ACO program aims to improve value and lower cost through incentives and penalties. Participating organizations receive a bonus or a penalty if overall spending for patients is based on meeting a financial benchmark. Performance on 33 quality measures determines the proportion of savings or losses shared by the ACO. In 2012, 32 health care provider organizations volunteered to participate in the Pioneer ACO program. In 2015, there were 19 participating organizations, according to CMS data .

agallegos@frontlinemedcom.com

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