Learning Systems for Accountable Care Organizations

Prepared for
U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation
stethoscope with computer in background

Accountable care organizations (ACOs) consist of doctors, hospitals, and other health care providers who work together to provide coordinated, high quality care to Medicare beneficiaries. These organizations accept responsibility not only for the quality of care but also for the cost of care, and they provide data to the Center for Medicare & Medicaid Services (CMS) so that the agency can asses their performance. ACOs that deliver quality care efficiently receive some of the savings from CMS that they generated for the Medicare program.

Since 2013, Mathematica has helped the CMS Innovation Center to accelerate the dissemination of innovative strategies for improving quality while reducing costs by operating learning systems for Medicare ACOs. Mathematica and its partners—HCMDM, the Institute for Healthcare Improvement, and Premier, Inc.—operate distinct learning systems for different types of Medicare ACOs. In 2019, the ACOs included those who are participating the Next Generation ACO Model; the Comprehensive End-Stage Renal Disease Care Model; the Vermont All-Payer ACO Model; and the Medicare Shared Savings Program, which includes ACOs who are participating in the Track 1+ Model and the Pathways to Success Program. Previously, Mathematica also supported the Pioneer ACO, Advanced Payment, and ACO Investment Models.

For ACOs, the learning systems provide a structure for peer-to-peer learning and the rapid dissemination of successful approaches across the country. Each year, Mathematica and its partners develop and host approximately 70 virtual learning events and 18 in-person meetings on topics tailored to the needs and interests of ACOs. Examples of learning events include webinars, affinity groups for ACOs with common interests, action groups that help ACOs achieve program goals, and regional and national in-person meetings. In addition, the learning system provides ACOs with individualized technical assistance, such as coaching calls, and data-driven tools, including claims reports and dashboards, to help ACOs implement, monitor, and improve their programs. Mathematica also develops written products such as toolkits, case studies, and other resources to further support individualized learning and to move policy and program implementation forward.

  • ACO Care Coordination Toolkit:
    • The ACO Care Coordination Toolkit describes strategies used by ACOs to manage their beneficiaries’ transitions across care settings while ensuring that they receive high quality, efficient care. The toolkit is the first in a broader series of resources that will explore different aspects of how Medicare ACOs provide value-based care. Through this and future toolkits, CMS intends not only to educate the general public about strategies that ACOs use to provide value-based care, but also to introduce actionable ideas to current and prospective ACOs to help them improve or begin operations.
  • Case studies:
    • These case studies highlight initiatives implemented by ACOs and ESCOs. New case studies are released by CMS and Mathematica quarterly.