Financial success varied widely across 10 medical groups in the demonstration. One saved an average of $818 per person, per year, while another saw per person, per year spending increase an average of $323, according to the analysis conducted for the CMS by not-for-profit research firm RTI International.
“We did find savings, which was one of the goals, but they were modest,” said Gregory Pope, a program director for RTI International who co-authored the report. “Not huge, but not trivial.”
On average, the 10 medical groups reduced Medicare spending by 2% per person, per year ($171) during the demonstration, which split the savings between the doctors ($102) and Medicare ($69, or 0.8% less than the program would have spent otherwise).
The results look familiar when compared with the early performance of more than 100 Medicare ACOs launched in 2012 under the healthcare reform law's shared-savings program. Their efforts also yielded mixed results and minimal overall savings.
Meanwhile, the demonstration program, like its ACO offspring, required participants to meet quality targets before they received bonuses. The quality targets seek to dissuade doctors and hospitals from cutting costs at the expense of good medical care.
And quality overall improved under the demonstration. Researchers found that to be the case even among those that saved the most. “It did not seem like the source of the cost savings was a decline in quality,” Pope said. (The quality results the CMS has published so far for ACOs in the shared-savings program are limited and mixed.)
Medical groups in the early demonstration focused their cost-saving efforts on the most expensive place to treat patients (the hospital) and the most expensive patients (complex, chronically ill and vulnerable). It worked. Spending for hospitalized patients dropped an average of $228 per patient, per year. Spending for patients at high risk of costly care declined $1,922 per patient, per year.
“It's not surprising,” Pope said. “That's kind of where the money is: people who are using services and are at risk of adverse health events and expenditures and high utilization.”
Researchers identified four strategies that, though not directly linked to savings, were widely adopted across the 10 demonstration medical groups: encouraging patients to do more to manage their medical care and health; establishing programs for doctors and nurses to more closely monitor and manage patients' care; using better coordination among hospitals, clinics and nursing homes as patients travel from one to another; and encouraging greater use of providers other than doctors.