Accountable Care – financial incentives for physicians, hospitals, and other healthcare providers to better coordinate care and improve the health of Medicare beneficiaries while lowering their costs – has failed in Massachusetts due to most care providers not signing up in the areas where it was being tested and cost savings not being found. Despite this the Governor of Mass is pushing for its statewide adoption via a new law, and the Mass pilot program at the Jordan Community ACO, a Plymouth, Mass.-based not-for-profit organization of 100 physicians from Plymouth Bay Medical Associates, Jordan Physician Associates, and specialty physicians from Jordan Hospital, is expanding into the Medicare program and will have more than 6,000 Medicare beneficiaries.

At the Federal level Medicare Accountable Care pilot projects previously authorized were studied by the Congressional Budget Office, resulting in a January CBO report on 10 such major care coordination and disease management initiatives that found insufficient savings to offset their cost.

But the idea is still moving ahead with the CMS designating 27 healthcare entities in 18 states (http://www.modernhealthcare.com/assets/pdf/CH79063410.PDF) with more than 10,000 physicians, 10 hospitals, and 13 smaller physician-led entities and serving an estimated 375,000 beneficiaries, as the first Medicare Shared Savings Program accountable care organizations, which are the in lieu of single payer with budget and cost control Obama solution sold to us in th ACA health insurance reform law
– and are I assume ACA’s most anticipated payment and delivery reform at the White House. /s

The announcement of the new 27 follows the January launch of the modified Pioneer Model ACOs with 32 healthcare groups and six Physician Group Practice Transition Demonstration organizations. CMS seems especially proud of the fact that just over half of the new 27 are physician-led, as this is said to mean that not only Hospitals will agree to be in the program. As to the CBO report that said they were not a cost savings but actually added to the cost of the system, CMS feels they have a new Accountable Care design that negates the CBO analysis of the prior Accountable Care effort. Five of the 27 ACOs will participate in the advance-payment ACO model, which provides upfront funding equal to the expected shared savings for rural and physician-based ACOs in the Shared Savings Program that need startup resources.

So with the new 27 organization in Medicare Accountable Care, the total number of Medicare beneficiaries participating in various shared-savings initiatives rises 1.1 million who will benefit from the 33 quality measures for care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care (http://www.gpo.gov/fdsys/pkg/FR-2011-11-02/pdf/2011-27461.pdf).

CMS in June will admit a new round of ACO groups into the program (there are 150 applications for recognition of Accountable care status by CMS, with 50 applications to enter the ACO program in June, now pending).