Bending the Spending Curve: The Role of Care Management in a Pioneer ACO

John Hsu
Peer-Reviewed Article
May 2017

This resource examines the impact of participation in a Pioneer ACO and its care management program on emergency department (ED) visits, hospitalizations, and Medicare spending.

  • The care management program was the ACO’s primary strategy for achieving its cost and quality goals under the Pioneer ACO program.
  • The program targeted participants who, based on information from their primary care physicians, were at elevated risk for future spending but whose risk appeared to be modifiable.
  • For participants, rates of ED visits were reduced by 6 percent, hospitalizations were reduced by 8 percent, and Medicare spending was reduced by 6 percent.
  • Targeting beneficiaries with modifiable high risks and shifting care away from the ED represent viable mechanisms for altering spending within ACOs.
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