Survey Says ACOs Are Continuing Growth

During 2012, more than 150 accountable care organizations participated in Medicare Shared Savings Initiatives, serving over 2.4 million Medicare beneficiaries. As many as 500 new ACOs are slated to serve Medicare during 2013. In the private health plan population, accountable care arrangements are proliferating with companies like Aetna and Cigna building national accountable care networks through provider collaborations.

The coming year brings much promise as well as potential pitfalls for stakeholders as accountable care arrangements mature.
Over the course of the first week of December Payers & Providers, MCOL and Accountable Care News jointly sponsored a survey to ask industry stakeholders their perspectives on accountable care organizations. Graphical data can be accessed on the Vitals page by clicking here.

Participants were asked to respond to seven items:

1. Your perspective/organizational affiliation

2. Is your organization involved with ACOs - including development, operation, or contracting arrangements?

3. When would you estimate ACOs would have a material impact in your marketplace?

4. If ACO Medicare pilots are not ultimately successful, will that cause commercial and Medicaid ACO arrangements to generally fail as well?

5. How satisfied are you with CMS's handling of the Medicare Shared Savings Program and the Pioneer model ACOs?

6. How confident are you that ACOs will actually generate the necessary savings?

7. Will bundled payments prove to be a more effective delivery and payment reform model than ACOs?

Organizational Involvement

For the third year in a row, a large majority (76.1%) of respondents said their organizations are involved with ACOs, including development, operation, or contracting arrangements. Purchasers were the most likely respondent category to say their organization was involved with ACOs at 81.8%, which was only slightly more than providers at 77.8% and vendor or others at 69.7%.

Marketplace Impact

The amount of respondents who said that ACOs currently have a material impact in the marketplace has gradually gone up, since this question was first asked in 2010. 26.4% of respondents in this year’s survey thought ACOs currently have an impact, up from 10.9% in 2011, and up from 6.8% in 2010. 91.8% of respondents believe ACOs will have an impact by 2020. Almost half (48.2%) think that ACOs either currently do have, or will have, in 2013, an impact in the marketplace. 33.6% of respondents think that ACOs will have a material impact in 2014 to 2015 while 10.0% think they will sometime from 2016 to 2020.

Those in the vendor or other category had the most optimistic outlook of ACO impact on the marketplace with 57.6% saying that ACOs either currently do have, or will have, in 2013, an impact. Purchasers and providers were not far behind, with over 40% of each group having the same optimism. No respondents in the provider or vendor/other categories said ACOs will never have an impact on the marketplace while 4.5% of purchasers said they never would.

Commercial and Medicaid ACO Success

A minority of respondents (27.5%) think that ACO Medicare pilots not being ultimately successful will cause commercial and Medicaid ACO arrangements to generally fail as well, while a plurality (42.2%) disagree with this statement. A third of respondents (30.3%) were unsure whether or not this statement was true.

Purchasers were mostly in agreement (63.6%) that the success of ACO Medicare pilots were not tied to the success of commercial and Medicaid ACO arrangements. Providers and vendor/others both had under 40% of respondents that Medicare’s success was tied to Medicaid’s and Commercial’s.

Satisfaction with CMS

The same, very low, percent of respondents (2.7%) were very satisfied with CMS's handling of the MSSP and the Pioneer Model ACOs. The percent of respondents on the other extreme, those who were very dissatisfied, was also low with only 5.5% answering this way.
A majority of respondents (54.5%) were neutral in their opinion of CMS’s handling of this. Only 15.5% of respondents were satisfied with CMS, and 21.8% said they were not satisfied. Overall, respondents did have a more negative attitude toward CMS, with 27.3% being either not satisfied or very dissatisfied, while only 18.2% were satisfied or very satisfied.

Providers were the most positive in their assessment of CMS’s handling of ACO programs, with 21.8% being satisfied or very satisfied. Vendors or others were the most negative on CMS’s handling, with 33.3% being not satisfied or very dissatisfied.

Confidence That ACOs Will Generate the Necessary Savings

Respondents were more confident than not, that ACOs will actually generate the necessary savings, with 40.0% saying they were either confident of very confident while a smaller portion of 31.8% were doubtful or very doubtful. While the plurality of 40% leaned towards the confident side, only 4.5% of respondents were very confident. 28.2% of respondents did not have an opinion on their confidence level.
Providers had the greatest confidence that ACOs will generate necessary savings with 43.6% saying they were confident or very confident, though vendor/others were not far behind, with 39.4% saying this. An equal amount of purchasers and vendor/others were doubtful or very doubtful they will generate the necessary savings at 36.4% each.

Bundled Payments

Respondents were fairly evenly split on whether bundled payments prove to be a more effective delivery and payment reform model than ACOs. 35.5% disagreed or strongly disagreed with this, 30.9% agreed or strongly agreed, and 33.6% had neutral feelings. Only a small amount of respondents on both sides felt strongly about their position, with only 11.8% strongly disagreeing and 5.5% strongly agreeing. Those in the vendor/other category were the only category that was evenly split between disagreeing/strongly disagreeing, being neutral and agreeing/strongly agreeing at 33.3% each. Purchasers and providers fell on opposite ends of the spectrum, with 45.5% of purchasers agreeing/strongly agreeing and 43.6% of providers disagreeing/strongly disagreeing.