OIG Issues Report on ACO Strategies for Transitioning to Value-Based Care Using Lessons From the Medicare Shared Savings Program

As part of the transition to value-based care, Medicare Shared Savings Program Accountable Care Organizations (ACOs) have developed a number of strategies to reduce Medicare spending and improve quality of care. This report describes the strategies that selected ACOs have found successful in reducing spending and improving quality of care. These strategies involve working to increase cost awareness in ACO physicians, engaging beneficiaries to improve their own health, and managing beneficiaries with costly or complex care needs to improve their health outcomes. Other strategies that ACOs found successful involve reducing avoidable hospitalizations, controlling costs and improving quality in skilled nursing and home healthcare, addressing behavioral health needs and social determinants of health, and using technology to increase information sharing among providers. ACOs also report challenges in each of these areas and describe the ways they overcame them.

The Centers for Medicare & Medicaid Services (CMS) recently made changes to the Shared Savings Program. As CMS carries out this and other ACO programs and develops new alternative payment models, it should support the use of these strategies and other successful strategies that emerge. These strategies can apply not only to ACOs but also to other providers committed to transforming the healthcare system toward value.

The OIG recommend that CMS take the following actions to support efforts to reduce unnecessary spending and improve quality of care for patients: (1) review the impact of programmatic changes on ACOs’ ability to promote value-based care; (2) expand efforts to share information about strategies that reduce spending and improve quality among ACOs and more widely with the public; (3) adopt outcome-based measures and better align measures across programs; (4) assess and share information about ACOs’ use of the skilled nursing facility (SNF) 3-day rule waiver and apply these results when making changes to the Shared Savings Program or other programs; (5) identify and share information about strategies that integrate physical and behavioral health services and address social determinants of health; (6) identify and share information about strategies that encourage patients to share behavioral health data; and (7) prioritize ACO referrals of potential fraud, waste, and abuse. CMS concurred with all of our recommendations.

The full report can be found at oig.hhs.gov/oei/reports/oei-02-15-00451.asp.

July 2019
U.S. Department of Health and Human Services
Office of Inspector General