The 20 accountable care organizations (ACOs) in the Centers for Medicare and Medicaid Services' (CMS) Pioneer ACO Model and the 333 Medicare Shared Savings Program ACOs generated more than $411 million in total savings in 2014, reports an August 25, 2015, CMS fact sheet. According to CMS, during the same period, 97 ACOs qualified for shared savings payments of more than $422 million by meeting quality standards and savings thresholds. Specifically, Pioneer ACOs in performance year 3 showed improvements in 28 of 33 quality measures and experienced average improvements of 3.6% across all quality measures when compared with performance year 2. These ACOs demonstrated particularly strong improvement in medication reconciliation (70% to 84%), screening for clinical depression and creating a follow-up plan (50% to 60%), and qualification for an electronic health record (EHR) incentive payment (77% to 86%). In addition, Medicare Shared Savings Program ACOs that reported in both 2013 and 2014 improved on 27 of 33 quality measures, including patients' ratings of clinicians' communication, beneficiaries' ratings of their doctors, screening for tobacco use and cessation, screening for high blood pressure, and EHR use. "These results show that accountable care organizations as a group are on the path towards transforming how care is provided," states CMS Acting Administrator Andy Slavitt in an August 25, 2015, press release. "Many of these ACOs are demonstrating that they can deliver a higher level of coordinated care that leads to healthier people and smarter spending." The agency notes that ACOs with more experience in the program tend to perform better over time.

HRC Recommends: The experience to date with ACOs underscores the importance of care coordination initiatives, such as medication reconciliation and patient follow up after discharge, to achieve healthcare savings. Facilities considering becoming a part of an ACO should review the experience of the Pioneer and Medicare Share Savings Program ACOs to identify best practices in care coordination for their own programs. They should also consider the lessons learned by those ACOs that did not achieve shared savings.