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First year of Pioneer ACO program saw small reduction in low-value services

A modest reduction in the use of low-value services was seen among health care practices that participated in Medicare’s Pioneer ACO program, according to recently published data in JAMA Internal Medicine.

Aaron L. Schwartz, PhD, department of health care policy at Harvard Medical School, and colleagues, constructed 31 claims-based measures of low-value services and analyzed data from 2009 to 2012 Medicare fee-for-service claims to assess whether the Medicare Pioneer ACO program reduced the use of low-value services. Schwartz and colleagues conducted a difference-in-differences analysis between Medicare fee-for-service beneficiaries using providers enrolled in the Pioneer ACO program and those using non-ACO providers (control group), before (2009 to 2011) and after (2012) Pioneer ACO contracts began.

Results demonstrated that prior to the Pioneer ACO program, use of low-value services were comparable between ACO and non-ACO groups.

The first year Pioneer ACO contracts were introduced, use of low-value services among the ACO-group decreased by 0.8 services per 100 beneficiaries (P < .001), according to the study. This equated to a 1.9% reduction in service quantity and 4.5% reduction in spending on low-value services (P = .004).

“Our findings, taken together with those of studies demonstrating spending reductions greater than Medicare bonus payments and improved or stable performance on measures of patient experiences and quality, are consistent with the conclusion that the overall value of health care provided by Pioneer ACOs improved after their participation in an alternative payment model. Finally, our study demonstrates the utility of novel measures of low-value services use for evaluating the effects of health care policy initiatives,” Schwartz and colleagues wrote. – by Casey Hower

Disclosures: Schwartz reports consulting for the Medicare Payment Advisory Commission on the use of measures of low-value care. Please see the full study for a list of all authors’ relevant financial disclosures.