​Medicare Shared Savings Program accountable care organizations (ACOs) saved almost $1 billion and generally improved the quality of the care they provided in their first three years of operation, according to an August 2017 report from the U.S. Department of Health and Human Services' Office of Inspector General (OIG). OIG reviewed data from 428 ACOs who served 9.7 million beneficiaries and compared costs and quality data collected by the Centers for Medicare and Medicaid Services (CMS) with similar data for non-ACO Medicare-participating hospitals. In addition to the cost savings, ACOs achieved improvement on 82% of the individual quality measures collected by CMS and outperformed their non-ACO counterparts on 81% of the measures. Much of the cost savings was driven by a subset of high-performing ACOs, which saved an average of $673 per beneficiary. Each of these ACOs had participated in the program for the entire three years, strengthening a trend that ACOs that participated for the longest time achieved the greatest spending reductions. These high performers also provided the most primary care visits and had the highest proportion of patients with multiple health conditions and other risk factors likely to drive up costs. OIG's findings are consistent with a CMS report in 2016, which found that certain “Pioneer" ACOs were able to improve quality and reduce costs (see HRC Alerts, August 31, 2016: CMS Accountable Care Organizations Continue to Improve Quality and Generate Financial Savings).

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 OIG report to identify best practices in care coordination for their own programs. They should also consider the lessons learned by ACOs that did not achieve shared savings.