CMS Innovation Center Evaluation Digest - Recent ACO Evaluations

February 2020 This newsletter highlights recently released Center for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) evaluation reports and publications. You can access reports by going to the data and reports page of the Innovation Center webpage.   Reports highlighted in this edition: Comprehensive End-Stage Renal Disease Care Model Accountable Care Organization Investment Model Next Generation Accountable Care Organization Model

Comprehensive End-Stage Renal Disease Care (CEC) Model Performance Year Two Evaluation Report Key Takeaways: The CEC Model is the first Medicare Accountable Care Organization (ACO) model that targets a particular clinical population. Results from the first two performance years of the CEC Model show specialty - oriented ACOs for beneficiaries with End Stage Renal Disease (ESRD) can reduce spending while improving key quality outcomes. Findings from the CEC evaluation can inform the development of future models focused on kidney disease as well as specialty-oriented ACO models focused on other chronic conditions. The Two Page Overview: Findings-At-A-Glance (PDF) The Report (includes an Executive Summary): Performance Year Two Evaluation Report (PDF) Additional Supporting Materials: Appendices (PDF) - Includes ACO level descriptions and findings, additional results from patient/caregiver survey, methods discussions and data collection instruments Model Page: Comprehensive End-Stage Renal Disease Care Model

Accountable Care Organization Investment Model Second Annual Evaluation Report Key Takeaways: Accountable Care Organization (ACO) Investment Model (AIM) funds were integral to ACO formation. In interviews, 63.2 percent responded that they would not have participated in the Shared Savings Program (SSP) without AIM funds. AIM ACOs decreased total Medicare spending and had greater reductions in total Medicare spending than similar non-AIM SSP ACOs. The reductions in Medicare spending and utilization were not offset by lower quality. The Two Page Overview: Findings-At-A-Glance (PDF) The Report (includes an Executive Summary): Second Annual Evaluation Report (PDF) Additional Supporting Materials: Appendices (PDF) - Includes ACO level descriptions and findings, additional results from patient/caregiver survey, methods discussions and data collection instruments Model Page: Accountable Care Organization Investment Model

Next Generation Accountable Care Organization Model Second Evaluation Report Key Takeaways: During its first two years of performance, the Next Generation Accountable Care Organization (ACO) Model was associated with a $123.2 million reduction in Medicare Parts A and B spending (down 0.6 percent, p<.05), but a $93 million increase in net Medicare spending (up 0.4 percent, not significant). In the 2017 performance year, the Model was associated with insignificant gross spending reductions and a significant net loss to Medicare ($115.6 million spending increase, up 0.7 percent, p<.05). Reductions in post-acute care spending contributed to a modest decline in gross Medicare spending, but this savings was offset by the shared savings disbursement. The model did not show a discernible impact on quality of care. Planned changes to the model’s financial methodology in Performance Years 4 and 5 (2019 and 2020) are expected to alter shared savings payments in those years and affect estimates of net impact when those years are evaluated. The Two Page Overview: Findings-At-A-Glance (PDF) The Report (includes an Executive Summary): Second Evaluation Report (PDF) Additional Supporting Materials: Technical Appendices (PDF) - Supporting tables and numbers to the report analyses, discussion of methodology, and information on ACOs participating in the model. Blog: Number of ACOs Taking Risk for Cost Increases Doubles under “Pathways to Success" - Administrator Verma discusses lessons learned from the Next Generation ACO evaluation among other thoughts on Medicare ACOs. (external link) Model Page: Next Generation Accountable Care Organization Model