CMS: ACO Prototype Succeeds

The Physician Group Practice (PGP) Demonstration—a five-year project with 10 physician group practices that helped define the Accountable Care Organization (ACO) model—is a success, the Centers for Medicare & Medicaid Services (CMS) says.

“After five years, this demonstration has shown positive results, including significant progress in areas of both quality improvement and savings in Medicare expenditures,” CMS said in a press release.

The ACO model provides incentives to health care providers to treat patients across health care settings, including doctors’ offices, facilities, and long-term care settings. The Medicare Shared Savings Program rewards ACOs that lower growth in health care costs while meeting performance standards on quality of care and “putting patients first,” CMS maintains.

Seven of the 10 physician groups in the study achieved benchmark performance on all 32 performance measures. The remaining three achieved 30 of the performance measures. This is an increase since the first year of the demonstration, when only two physician groups achieved the benchmarks.

Participating groups include: Billings Clinic in Billings, Mont.; Everett Clinic in Everett, Wash.; Forsyth Medical Group in Winston-Salem, N.C.; Geisinger Health System in Danville, Penn.; Middlesex Health System in Middletown, Conn.; Park Nicollet Health Services in St. Louis Park, Minn.; St. John’s Health System in Springfield, Mo.; University of Mich. Faculty Group Practice in Ann Arbor, Mich.; Marshfield Clinic in Marshfield, Wis.; and Dartmouth-Hitchcock Clinic in Bedford, N.H.

Under the PGP Transition Demonstration, physician groups must have lower growth in Medicare costs relative to a national benchmark to share in savings. The PGP Transition Demonstration design includes a retrospective assignment algorithm based on services provided by primary care providers—rather than all specialties, as was done under the initial PGP Demonstration. This methodology underscores the important role primary care providers play in coordinating care to achieve better quality and cost outcomes. Quality performance continues to be a key aspect of the demonstration’s design; and the PGP Transition Demonstration includes new measures and areas of focus, including claims and chart-based measures, composite measures, and patient experience  measures.

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