Savings From ACOs—Building on Early Success
Authors: J. Michael McWilliams
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions20 December 2016Savings From ACOs—Building on Early SuccessJ. Michael McWilliams, MD, PhDJ. Michael McWilliams, MD, PhDFrom Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-1846 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail With 434 participating organizations, the Medicare Shared Savings Program (MSSP) represents the signature payment reform of the Patient Protection and Affordable Care Act, the largest new payment model implemented by the Centers for Medicare & Medicaid Services (CMS), and the leading reason that the Department of Health and Human Services' ambitious goal of tying 50% of fee-for-service Medicare payments to such models by 2018 remains possible. For each accountable care organization (ACO) in the MSSP, the program sets a benchmark for total spending in an attributed patient population and provides incentives to reduce spending below the benchmark while providing high-quality ...References1. McWilliams JM, Hatfield LA, Chernew ME, Landon BE, Schwartz AL. Early performance of accountable care organizations in Medicare. N Engl J Med. 2016;374:2357-66. [PMID: 27075832] doi:10.1056/NEJMsa1600142 CrossrefMedlineGoogle Scholar2. Department of Health and Human Services and Centers for Medicare and Medicaid Services. Medicare program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentive under the physician fee schedule, and criteria for physician-focused payment models. 2016. Accessed at https://www.federalregister.gov/articles/2016/05/09/2016-10032/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm on 30 September 2016. Google Scholar3. McWilliams JM. Changes in Medicare Shared Savings Program Savings from 2013 to 2014. JAMA. 2016. [PMID: 27612292] doi:10.1001/jama.2016.12049 CrossrefMedlineGoogle Scholar4. McWilliams JM, Chernew ME, Dalton JB, Landon BE. Outpatient care patterns and organizational accountability in Medicare. JAMA Intern Med. 2014;174:938-45. [PMID: 24756690] doi:10.1001/jamainternmed.2014.1073 CrossrefMedlineGoogle Scholar5. Department of Health and Human Services and Centers for Medicare and Medicaid Services. Medicare program; Medicare Shared Savings Program; Accountable care organization-revised benchmark rebasing methodology, facilitating transition to peformance-based risk, and administrative finality of financial calculations. Final rule. 2016. Accessed at https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-13651.pdf on 30 September 2016. Google Scholar6. Kaiser Family Foundation. The facts on Medicare spending and financing. 2015. Accessed at http://files.kff.org/attachment/fact-sheet-the-facts-on-medicare-spending-and-financing on on 30 September 2016. Google Scholar7. Douven R, McGuire TG, McWilliams JM. Avoiding unintended incentives in ACO payment models. Health Aff (Millwood). 2015;34:143-9. [PMID: 25561655] doi:10.1377/hlthaff.2014.0444 CrossrefMedlineGoogle Scholar8. Rose S, Zaslavsky AM, McWilliams JM. Variation in accountable care organization spending and sensitivity to risk adjustment: implications for benchmarking. Health Aff (Millwood). 2016;35:440-8. [PMID: 26953298] doi:10.1377/hlthaff.2015.1026 CrossrefMedlineGoogle Scholar9. Colla CH, Lewis VA, Tierney E, Muhlestein DB. Hospitals participating in ACOs tend to be large and urban, allowing access to capital and data. Health Aff (Millwood). 2016 Mar;35 3 431-9. [PMID: 26953297] doi:10.1377/hlthaff.2015.0919 CrossrefMedlineGoogle Scholar10. Mostashari F, Sanghavi D, McClellan M. Health reform and physician-led accountable care: the paradox of primary care physician leadership. JAMA. 2014;311:1855-6. [PMID: 24723035] doi:10.1001/jama.2014.4086 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.Disclaimer: The content of this article is solely the responsibility of the author and does not necessarily represent the official views of the Laura and John Arnold Foundation or the National Institutes of Health.Grant Support: Supported by grants from the Laura and John Arnold Foundation and the National Institute on Aging of the National Institutes of Health (P01 AG032952).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1846.Corresponding Author: J. Michael McWilliams, MD, PhD, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115; e-mail, [email protected]med.harvard.edu.Author Contributions: Conception and design: J.M. McWilliams.Analysis and interpretation of the data: J.M. McWilliams.Drafting of the article: J.M. McWilliams.Critical revision of the article for important intellectual content: J.M. McWilliams.Final approval of the article: J.M. McWilliams.Obtaining of funding: J.M. McWilliams.This article was published at www.annals.org on 11 October 2016. 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Michael McWilliams, MD, PhD 20 December 2016Volume 165, Issue 12Page: 873-875KeywordsAccountable care organizationsChildrenDisclosureForecastingHealth insuranceMedicareMotivationPatient Protection and Affordable Care ActPatientsPerformance measures ePublished: 11 October 2016 Issue Published: 20 December 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...