As one of the country’s first Medicare Pioneer Accountable Care Organizations, Partners HealthCare demonstrated the success of the model by delivering high-quality care while generating $36.7 million in cost savings between 2012 and 2016. Building on this success, in 2017 Partners chose to continue to optimize the care for Medicare beneficiaries by participating in the Centers for Medicare & Medicaid Services (CMS) Next Generation ACO Model as CMS phased out the Pioneer ACO Model. As a result, the Partners System became one of the largest Next Generation ACOs, providing quality care to 88,000 Medicare patients, while beating the Medicare cost growth benchmark and achieving a care quality score of 100%.
These milestones provide significant headway in Partners’ overall efforts to enhance population health while balancing care quality with affordability. The new CMS Next Generation ACO Model helps ACOs experienced with coordinating population health care assume higher levels of financial risk and reward than the previous Pioneer Model. The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for original Medicare fee-for-service beneficiaries.
“Participation in the Next Generation ACO has allowed us to expand clinical programs that reduce costs and improve quality across our clinical network."Sree Chaguturu, MD, Chief Population Health Officer at Partners HealthCare
Within the Partners system, that participation takes shape through a variety of population-targeted programs. One such initiative, the well-established integrated care management program (iCMP), provides a strong framework for longitudinal care coordination for high-risk patients. In 2017, 13,000 patients—68% of whom were Medicare patients—participated in this program. Their participation has resulted in measurable improvement across key quality measures: Partners estimates that among ACO patients enrolled in iCMP compared to non-participants, the per member per month cost is $125 lower, the rate of ED visits is 10.5% lower, and medical hospitalizations are 15.5% lower.
“The Next Generation ACO Model challenges us to continue to find ways for our physicians, nurses, and care team members to come together for patients across a wide variety of care settings to achieve the vision of high quality, patient-centered care delivered in a financially sustainable manner. We are pleased with our 2017 results and look forward to continued participation in the program,” says Sandhya Rao, MD, Senior Medical Director for Population Health at Partners and Medical Director for the Next Generation ACO Model.