Accountable Care Organizations (ACOs) are designed to shift the burden of excess costs to providers, by challenging them to provide better, more coordinated care to a large group of patients at the lowest cost possible.
Lowering the cost of care for any population is most effective when patients with frequent Emergency Department (ED) or hospital inpatient visits are targeted. These patients, often called super-utilizers, represent the highest costs in the system, and have higher healthcare costs than larger segments of the population. Super-utilizers typically have multiple chronic diseases that are poorly managed, providing ACOs with an easy place to focus.
While Medicare ACOs show mixed results, some privately-run ACOs show early promise in lowering the cost of care for a targeted population. In California, WellPoint’s Anthem Blue Cross and HealthCare Partners teamed up to cover 55,000 patients, and saved $4.7 million in just the first half of 2013. These savings are the result of reduced hospital admissions and ED visits, shorter inpatient stays, and fewer lab and radiology tests, as compared to a control group of patients. Patients in the ACO also had better health indicator outcomes, including lower LDL cholesterol among diabetic patients – indicating that patients in the ACO did not receive less care, but received better, more effective care in comparison to the control group.