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Medicare Accountable Care Organizations Evaluation

Accountable Care Organizations are groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high-quality care to the Medicare patients they serve.

The Centers for Medicare & Medicaid Services (CMS) hired a team that includes Abt Associates to conduct an evaluation of the Center for Medicare and Medicaid Innovation’s (CMMI’s) Accountable Care Organization (ACO) initiatives. The focus of the evaluation is to assess the extent to which the Pioneer ACOs and the Advanced Payment Medicare Shared Savings Program ACOs are able to achieve the goals of the triple aim of better health care, better health, and lower costs.

The team, led by L&M Policy Research, LLC, also includes Avalere Health, Social, & Scientific Systems, and Truven Health Analytics.

The evaluation includes the following activities:

Topic-Focused Quarterly Assessments: Nine quarterly telephone discussions were held with a cohort of ACOs on a range of topics such as administrative functions and infrastructure, leadership and governance, financing/payment models and contract design, care coordination, special populations, and access to care. Additional information was captured through special-topic web-based surveys completed by the evaluation team or ACO staff.

Case Studies: In-person site visits with individual and group interviews and focus group discussions with ACO administrative and clinical staff.

ACO Profiles: Each ACO team compiled an ACO profile using information collected through an environmental scan, site visit interviews, and quarterly telephone interviews.

Analyses of the Learning Networks designed for ACOs to share experiences and best practices in developing their organizations.

Secondary Data Analysis: Abt, with L&M and other partners, estimated the impact of the Pioneer ACOs and Advanced Payment ACOs on a wide range of Medicare expenditure and utilization measures using claims data.

Special Reports: Abt conducted a mixed-methods study of CMS’ waiver of the skilled nursing facility (SNF) three-day prior hospitalization rule used by some Pioneer ACOs. The study examined the ACOs’ implementation strategies and experiences with the waiver using qualitative data collection and analyses. Findings from an evaluation of the waiver impacts are forthcoming.

North America