Health Systems May See More Savings With Medicare Advantage vs. Medicare ACOs

A new study published in JAMA Network Open raises questions about whether health systems can actually achieve significant savings through the Medicare Shared Savings Program (MSSP), or if Medicare Advantage could be a better bet. To identify spending patterns in MA and MSSP’s Accountable Care Organizations (ACOs), researchers studied the characteristics and claims data of about 16,000 Medicare patients at Ochsner Health System (OHS), a large, academic system in Louisiana, from 2014 to 2018. Ochsner joined MSSP in 2013, and its ACO hosts more than 2,200 providers. It also offers MA plans via a partnership with Humana Inc. Researchers identified four common disease states among Medicare patients — hypertension, congestive heart failure (CHF), diabetes and chronic kidney disease (CKD) — and endeavored to gather highly detailed clinical data about each patient, such as Medicare-Medicaid dual eligibility status and whether the patient resided in a low-income ZIP code, to control for variations in beneficiary risk that could impact spending. Despite these tight controls, significant spending differences existed between the MA and MSSP groups.   The study authors asked CMS to consider changes to the MSSP design, such as encouraging direct contracting arrangements that would increase spending flexibility for participating clinicians, and adopting more generous MSSP spending targets that could align the program’s financial benchmarks more closely with MA.

NOTES: SES = socioeconomic status; PCP = primary care physician.   SOURCE: “Evaluation of Spending Differences Between Beneficiaries in Medicare Advantage and the Medicare Shared Savings Program,” JAMA Network Open. 2022;5(8):e2228529. doi:10.1001/jamanetworkopen.2022.28529   From Radar on Medicare Advantage Learn more about subscribing to AIS Health's publications.