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Medicare accountable care medical groups cover almost two-thirds of U.S.

Now 424 ACOs dedicated to better care for seniors, others in Medicare fee for service

April 22, 2015 – Almost 70 percent of the U.S. population now lives in communities served by accountable care organizations (ACOs), which were created by Obamacare to provided Medicare patients with better coordinated and higher quality health care. A new analysis also shows that 44 percent live in areas served by two or more ACOs.

U.S. Map showing areas covered by Medicare Accountable Care OrganizationsThe figures come from new research by the consulting firm Oliver Wyman, based on the Department of Health and Human Services’ announcement of the latest class of ACOs approved to participate in Medicare’s ACO programs.

The latest round of approvals in January brings the total of Medicare ACOs to 426, up from 368 in January 2014 and 134 in 2013. Oliver Wyman has identified an additional 159 ACOs, bringing the estimated total to 585, an increase of 12 percent from the previous year.

“One of the key reforms in the Affordable Care Act is creating Accountable Care Organizations (ACOs). ACOs, are groups of doctors, hospitals, and other health care providers that have agreed to work together to give their Medicare patients better coordinated, high quality care,” according to the CMS blog at the time of the last announcement in January.

“To the extent that they succeed in providing more effective and efficient care, they can share in the savings to the Medicare program. Interim financial results for 114 ACOs that began work in 2012 show that they generated $128 million in savings for the Medicare trust fund in the first year —while maintaining high quality patient care.


 

“Additionally, initial results from an independent evaluation of 23 Pioneer ACOs, which are those that have more experience with coordinated care, show that they saved the Medicare program $147 million in their first year of operation.”

Despite well-publicized departures from Medicare’s Pioneer ACO Program, the concept appears to now have taken hold and is becoming a driving force in better care for Medicare patients.

Key findings:

  ●  About 5.6 million Medicare beneficiaries, or about 11 percent of total Medicare beneficiaries, now receive their healthcare from ACOs participating in Medicare’s ACO programs.

  ●  These organizations also provide care to 35 million non-Medicare patients, about 6 percent more than last year.

  ●  ACOs collectively serve between 49 and 59 million U.S. residents, or between 15 and 17 percent of the population.

“ The slowdown we’re seeing in the growth of ACOs was almost inevitable, given the pace of change of the past two years,” says Niyum Gandhi, a partner in Oliver Wyman’s Health & Life Sciences practice and one of the firm’s experts on ACOs.

“The next big spurt will be more in effectiveness and sophistication than it will be in growth in numbers of ACOs." Gandhi also cites that the changes to the rules that CMS proposed this past winter, especially the Next Generation ACO model, could give ACOs the boost they need to compete more aggressively.

●  The full report is available here.

●  More about Accountable Care Organizations (ACO)

●  More on the map of ACO coverage

●  A list of all ACOs in the U.S. at Medicare.

●  About Oliver Wyman - Oliver Wyman reports to be a global leader in management consulting. The firm's 3,700 professionals “help clients optimize their business, improve their operations and risk profile, and accelerate their organizational performance to seize the most attractive opportunities”. Oliver Wyman is a wholly owned subsidiary of Marsh & McLennan Companies [NYSE:MMC]. For more information, visit www.oliverwyman.com.

●  For the latest on the new world of healthcare, visit the Oliver Wyman blog, Transforming Healthcare, at blogs.oliverwyman.com/healthcare/.


From the SeniorJournal.com archives of related Medicare news:

Medicare Accountable Care Organizations may add emphasis on primary care services

Shared Savings Program Proposed Rule reflects focus on primary care and improved incentives for participation, quality, and efficiency - Dec. 2, 2014

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