In their article, Nyweide and colleagues1 present results from the first 2 years of the Pioneer accountable care organization (ACO) program. Like the Medicare Shared Savings ACO Program (MSSP), the Pioneer program rewards health care organizations that accept accountability for a population of beneficiaries and score well on measures of cost, quality, and patient experience. The Pioneer program gives ACOs the opportunity to gain a greater share of any cost savings they produce but also gives them more risk if costs for their population exceed targets. ACOs are one of the centerpieces of the Affordable Care Act, and understanding how they have performed is critical in the United States. Using a difference-in-differences approach, Nyweide et al compared the cost of care for Medicare beneficiaries for whom the 32 Pioneer ACOs were responsible with cost for other beneficiaries in their areas. The increase in cost per beneficiary was $36 per beneficiary per month less for Pioneer beneficiaries in 2012 and $11 less in 2013. Smaller increases in the cost of hospital inpatient care accounted for the largest share of the difference (nearly 50%), whereas physician services accounted for nearly 25%. Pioneer beneficiaries also had smaller increases in outpatient procedures, imaging, tests, and emergency department visits, although the differences between Pioneer beneficiaries and and those in the comparison group were small. Despite these decreases in utilization, Pioneer beneficiaries’ reported experience of care, including timeliness and ease of obtaining care, access to specialists, and clinician communication, was at least as high as for beneficiaries in the fee-for-service Medicare and Medicare Advantage programs.
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