Nearly 70 percent of U.S. residents live near accountable care organizations (ACOs), according to an Oliver Wyman report released this month. There are now 585 ACOs, an increase from 522 in 2014 and 258 in 2013.
With the healthcare industry focusing more on value-based care and cost savings, more physicians and hospitals are joining ACOs, in which they work together to coordinate care for patients.
The Centers for Medicare & Medicaid Services (CMS) launched ACO initiatives as part of the Patient Protection and Affordable Care Act, which was passed in March 2010. The number of ACOs participating in CMS initiatives has grown from 134 in 2013 to 368 in 2014 to 426 this year.
Approximately 11 percent of Medicare beneficiaries (5.6 million people) are now receiving care through ACOs, according to the report. It also mentioned that most ACOs in the CMS program serve non-Medicare patients, as well.
Niyum Ghandi, the report’s author and a partner at Oliver Wyman, wrote that it was more difficult to count and identify non-CMS ACOs because there was no list or official ACO definition. Oliver Wyman defined a non-CMS ACO as a provider organization with at least one shared-savings or shared-risk arrangement with at least one commercial payer, but not CMS.
By those standards, between 9 million and 15 million people receive their care through non-CMS ACOs.
Top ACOs have cut costs by 20 percent to 40 percent, delivered quality care and received high patient satisfaction scores, according to Oliver Wyman. However, most have not achieved that level.
“Part of the reason is that CMS’s rules actually make it difficult for some of the best players in the field to earn shared savings payments,” Ghandi wrote. “Without them, these organizations cannot afford to invest as they’d like to – and as the rest of us should hope that they would. The changes to the rules that CMS proposed this past winter – and especially the Next Generation ACO model – may give the best ACOs the push they need to start competing more aggressively.”