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Invited Commentary
November 2015

Precision Health Care Efficiency via Accountable Care Organizations

Author Affiliations
  • 1Clinical Excellence Research Center, Stanford University, Stanford, California
JAMA Intern Med. 2015;175(11):1825-1827. doi:10.1001/jamainternmed.2015.5322

The ratio of heat from political conflict to light remains high with respect to Medicare's value-based payment policies and, specifically, whether Accountable Care Organizations (ACOs) can slow health care spending growth without jeopardizing the quality of care.

The study by Schwartz et al1 suggests that some ACOs are capable of such precision. The researchers examined Medicare’s Pioneer ACO Program that appealed to health care organizations more confident of their ability to both lower costs and improve quality because it posed the greatest risk of financial loss and gain. Encouragingly, the researchers found that “the first year of the Pioneer program was associated with a 4.5% differential reduction in spending on low-value services, substantially larger than the 1.2% reduction in overall spending previously estimated with the same methods. This finding suggests that Pioneer ACOs targeted [reduction of] low-value services….”1

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