ACOs Improve Quality, Physician Burnout As New Opportunities Emerge

Accountable care organizations (ACOs) aim to improve healthcare quality for patients while reducing costs. Even as healthcare providers have operated in an unstable industry for the past few years, ACO programs have continued to achieve shared savings and promote the shift to value-based care.

Programs like the Medicare Shared Savings Program (MSSP) and Direct Contracting—soon to be ACO REACH—incentivize providers to bear more financial risk in exchange for shared savings.

In particular, MSSP has been a champion of value-based care, according to Dr. Brian Steele, chief medical officer of Collaborative Health Systems (CHS).

“It’s still driving billions of dollars of savings—$1.6 billion in 2021 alone and hundreds of ACOs participating. It’s got risk and non-risk-based contracts, and by far, it’s done more for value-based care than any other program,” Steele told RevCycleIntelligence in a recent interview.

The recently released MSSP performance results highlighted the continued success of the program. According to CMS, 58 percent of ACOs earned payments for their quality and cost performance, saving $1.6 billion in 2021. Before accounting for shared savings payments, Medicare saved a total of $3.6 billion.

Savings achieved in 2021 were slightly lower than in 2020, which saw $1.9 billion in shared savings payments. This was likely due to COVID-19-related factors. In 2020, preventive care, routine appointments, and issues unrelated to COVID-19 were delayed, leading to a decline in healthcare utilization. This also led to decreased medical expenses, which drove higher savings for the program.

“That said, the fact that there was only a slight decrease from 2020 to 2021 shows promise that ACOs are continually growing and evolving to achieve greater savings,” Steele pointed out.

“It’s especially important to recognize that in 2021, we still had a high level of pandemic-related services happening, but also the return of normal services. The fact that we were still able to drive savings is a critical testament to the program.”

Healthcare practices have been experiencing high rates of physician burnout since the pandemic hit. Physician burnout likely impacted MSSP performance but may also motivate providers to leverage value-based care practices.

Addressing physician burnout is a critical component of achieving Quadruple Aim success. Formerly the Triple Aim, the Quadruple Aim presents a framework for improving population health, patient experience, healthcare costs, and provider wellbeing.

While the goal of value-based care is to generate cost savings and care quality improvements, healthcare organizations will not see these results without concomitantly taking steps to reduce physician burnout.

“[Physician burnout] remains a critical issue across all aspects of healthcare because it affects care, quality, cost efficiency, accessibility, and more,” Steele explained.

“That transition from fee-for-service or volume-driven healthcare to value-based healthcare is a clear path to help alleviate the tensions that create physician burnout. It puts more emphasis on coordinated and preventive care, and it speaks to the values that physicians often have, which is about driving higher quality and connecting with their patients on a more personal level than we see happening in volume-driven fee-for-service care.”

During the pandemic, hospital systems became more interested in how value-based care could help decrease physician burnout, leading to increased participation in value-based programs, Steele noted.

While 2021 MSSP savings declined slightly, CHS ACOs saw a 13 percent increase in savings, Steele mentioned. The organization saw $40.87 million in total savings and $16.9 million in shared savings.

While MSSP continues to generate savings, the future of ACOs may be focused on CMS Innovation models, as the Direct Contracting model plans to transition to the ACO REACH model in 2023.

“Overall we’re encouraged by the transition,” Steele said. “The change signals further advances in value-based care and it builds upon the lessons from prior models, also placing greater emphasis on health equity and health disparities. Having higher levels of clinical and financial responsibility with ACOs is a critical component to enable the success of models and ACO REACH does that.”

In addition, CMS has stated that the new model will require a higher level of provider governance. CHS has designed its program to incorporate these attributes, and Steele believes it should be the standard for all ACOs.

As for the backlash that Direct Contracting has received in the past, Steele thinks there are some misunderstandings about the model, though he acknowledged he could not speak to all of the issues providers have experienced.

“It was never intended to, and does not restrict patient choice, nor does it restrict access to providers, benefits, or services,” Steele shared. “That level of misunderstanding was maybe inherent in the name choice, or just a misunderstanding that was happening in general, and that created a lot of the uncertainty and fear about the program itself.”

However, Steele applauded CMS for reforming the model by introducing changes that address health equity. In addition, he noted that the agency is listening to ACOs and including them in the conversations about how ACO programs are evolving.

Going forward, ACOs must continue prioritizing patient care to maximize future savings.

“Evolving the care and the way we respond to the needs of our beneficiaries and patients, and becoming even more patient-centric than we have been, and meeting them where, when, and how they need services and support is crucial,” Steele highlighted.

As CMS continues to evolve ACO programs, the agency could benefit from more patient and provider perspectives of the challenges and opportunities the programs present.

“CMS should further explore new tools that ACOS and REACH ACOs can implement, such as stronger incentives to use, preferred networks that demonstrate improved quality, and reduced costs,” Steele recommended.

Additionally, Steele noted that CMS should transition tools that were successful in innovation models to MSSP, which could help MSSP generate higher savings.

Although these programs have proved that ACOs can produce savings, some providers are still hesitant to join. This is primarily due to fear, uncertainty, and doubt, according to Steele.

“Inherently, we’re used to what we’ve been doing, and the transition to something new is often the most challenging spot, and more often it’s the anticipation of the transition that’s the hardest part,” Steele said.

Wondering how ACO participation will impact patients, care outcomes, staff, and cash flow are typically the initial concerns providers have.

“That’s where we, as an organization, can really help providers understand how to transition and help absorb some of those challenges by presenting to them the expertise, the knowledge, the awareness, as well as the ability to absorb risk in those transitions moving to value-based care success.”