Connecticut Medicare ACOs overspent by $45 million in 2016

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Data from CMS show that in 2016 Connecticut’s Accountable Care Organizations (ACOs) together spent $45 million more on care for Medicare beneficiaries above risk-adjusted benchmark spending levels. ACOs are networks of providers across the continuum that coordinate care for people and receive a share of the savings they generate. All of Connecticut’s Medicare ACOs only accept upside risk, meaning that they share in potential savings but do not share in losses. Only one Connecticut ACO, ProHealth Physicians ACO, saved money on the care of their Medicare patients, earning a $6 million shared savings payment. The average Connecticut ACO overspent their benchmark by $5.6 million in 2016. The average ACO nationally saved $1.5 million from the benchmark but Medicare has not saved enough money on the program to cover program costs.

 

All Connecticut ACOs met Medicare’s quality standards, but only four of 432 ACO nationally didn’t meet those standards. There is little evidence that the quality metrics are meaningful or reflect health outcomes.

 

One in four Connecticut Medicare beneficiaries (164,348 people) was in an ACO in 2016 when there were eight ACOs covering Connecticut beneficiaries. Not all ACOs in participate in Medicare, including most ACOs in Connecticut Medicaid’s controversial new PCMH Plus program.

 

ACO Members Savings (Losses) Costs/ member Readmissions ED visits

 

Avoidable Admissions: heart failure
St. Francis 20,845 $ (857,072)  $ 11,256 185 717 14.6
Hartford Healthcare 23,264 (9,976,071) 13,557 201 891 17.8
ProHealth 30,480 12,475,518 9,827 151 641 15.8
CMG 17,717 (4,361,956) 10,729 155 661 13.9
Valley Health 7,554 (3,218,330) 10,582 167 843 12.7
Life Health 11,993 (145,560) 11,613 173 861 18.4
WCHN 27,957 (21,993,591) 11,290 151 626 13.3
NEMG 24,538 (17,062,438) 11,680 174 646 14.2
CT average   (5,642,438) 11,317 170 736 15.1
US average   1,509,129 10,755 168 746 14.5

 

Notes: 2016 Medicare ACOs that primarily serve Connecticut patients; CMG = Community Medical Group, New Haven; Valley Health = Valley Health Alliance, St. Mary’s Hospital; Life Health = Life Health Services, Middlesex and Griffin Hospitals; WCHN = Western CT Health Network, Danbury, New Milford and Norwalk Hospitals; NEMG = Northeast Medical Group, Yale-New Haven Health System; Readmissions are 30-day, all-cause, per 1,000 discharges; ED visits are per 1,000 members; Avoidable admissions are Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8)

 

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