The results, which include performance for about 250 ACOs in the Shared Savings Program and the CMS Innovation Center's Pioneer Model, underscore the uneven performance that has characterized early efforts to overhaul healthcare financing. The latest Medicare results—which also show significant gains on measures of quality—add important information to the limited data available on the viability of the model.
The CMS launched the two tests of accountable care in 2012 and another wave of ACOs in January 2013 under a provision of the Patient Protection and Affordable Care Act. The programs reward hospitals and doctors that hold Medicare enrollee health spending below target and meet quality benchmarks. Medicare penalizes Pioneer ACOs that fail to do so. Some Shared Savings ACOs can also see penalties.
Eleven of 23 Pioneer ACOs earned financial bonuses that totaled $68 million during the program's second year. Three faced penalties after health spending accelerated. Performance on quality improved for 28 of 33 measures.