ACO contracts may generate 'spillover' cost savings for nonparticipants
Tuesday, September 10, 2013
by: Policy Team

Section: Public Policy and Advocacy

According to a study published in the Journal of the American Medical Association, “Changes in Health Care Spending and Quality for Medicare Beneficiaries Associated With a Commercial ACO Contract,”there is potential for ACO-type payment models to promote systemic change in delivery.  The study suggests that spillover effects for patients served by the same provider but not a part of the ACO should be considered when evaluating the value of an ACO. 
The study examined spending and quality measures for Medicare patients served by 11 provider organizations that entered into Blue Shield’s Alternative Quality Contract (AQC) that provided incentives for reducing costs and improving the quality of care.  The report concludes that payment incentives executed with the AQC also reduced costs for Medicare patients outside the contract.    
Though the cost savings were evident for Medicare patients outside the ACO, the quality measures did not consistently improve these beneficiaries. The study discovered evidence of improvement in one process measure of quality for Medicare beneficiaries with cardiovascular disease and diabetes, but not in three others measured by the AQC, and not in hospitalizations that might be prevented by better cardiovascular disease and diabetes control rewarded by the AQC.  The discrepancies suggest that quality improvement efforts by participants may have been targeted more specifically to AQC enrollees. 
The study was published in the Aug. 28 edition of JAMA and can be found here. 
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