Harvard: Home Care Yields Biggest Savings in ACOs

At-home care agencies have long expressed the desire to join accountable care organizations (ACOs), despite not necessarily being invited to sit at the ACO table. Still, there’s evidence that including at-home care would benefit ACOs in more ways than one.

In fact, increasing use of at-home care plays a major role in the ability of ACOs to cut costs, according to a study recently published in JAMA Internal Medicine.

For the study, J. Michael McWilliams of the Harvard Medical School and other researchers compared fee-for-service Medicare claims from beneficiaries in ACOs and beneficiaries not in ACOs before and after they began participating in the Medicare Shared Savings Program. The random, 20% sample of Medicare beneficiaries the researchers analyzed included over 1.5 million stays in skilled nursing facilities and more than 8.3 million hospital admissions.


Between 2012 and 2014, a group of 114 ACOs produced a 9% drop in post-acute spending, which amounted to about $106 per beneficiary, the researchers found.

The cost savings were driven by fewer patients being discharged into a facility, as well as by reductions in the duration of facility stays and acute inpatient care.

Additionally, ACO savings grew over time, and they appear to be most pronounced where the incentives to save are greater, Medscape reported, citing the study findings.


Relatedly, McWilliams believes that ACOs are incentivized correctly to achieve cost savings goals.

“We now know ACOs are working, so let’s not abandon that direction or weaken the incentives in it,” McWilliams said in an audio supplement to the study.

Read the full text of the study here.

Written by Mary Kate Nelson

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