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How to improve your risk performance

    “What makes an ACO successful—especially MSSP E track?” That’s the question a Director of Population Health recently asked me.

    Previous ACO research suggests success factors include being physician-led, duration of beneficiary attribution, site of care shifts from IP to OP and simply taking risk. Other research concludes the size of the total medical expense budget and beneficiary demographic attributes, particularly regarding disability, play an important role in ACO success. A recent study on ACO financial performance, Promise v. Practice: The Actual Financial Performance of Accountable Care Organizations, concludes that on balance the Medicare ACO program at best was financially neutral. Based on the aggregate data it would be unwise to disagree. At the same time some ACOs appear to perform very well financially in terms of not only generating savings for the ACO but also in lower beneficiary expenses.

    With the existing research in mind, we conducted our own analysis to answer the question. Based on MSSP ACO performance data, what made an ACO more likely to be successful?

    Our main takeaways:

    • Take risk: Risk taking ACOs earned significantly more savings than non-risk taking ACOs. Reading between the lines here, organizations more formally committed to risk more formally committed to demand destruction and savings generation.
    • Manage visit types through site-of-care shifts: This again is where full risk arrangements may reveal even greater success. Changing utilization patterns, assuming quality remains the same or improves, is a good thing.
    • Leverage the primary care enterprise: Increasing the number of primary care encounters appears to directly translate into better management of unplanned admissions and drives better performance on several important quality measures

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