Financial Favorability of Pioneer ACO Spending Targets in 2008, by Geographic Area.*
| Areas | Absolute Favorability ($ per beneficiary) |
Relative Favorability (% deviation from actual spending) |
||||
|---|---|---|---|---|---|---|
| Mean | Range | Interquartile Range |
Mean | Range | Interquartile Range |
|
| HRRs | ||||||
| All (n=306) | −74 | −1426 to 972 | −203 to 80 | −0.7 | −14.6 to 14.1 | −2.5 to 1.0 |
| Low-spending, low-growth (n=115) | 95 | −270 to 972 | −30 to 186 | 1.3 | −3.2 to 14.1 | −0.4 to 2.6 |
| Low-spending, high-growth (n = 85) | −185 | −846 to 205 | −308 to −46 | −2.3 | −9.8 to 2.4 | −4.0 to −0.6 |
| High-spending, low-growth (n=46) | 6 | −581 to 514 | −97 to 148 | 0.1 | −4.7 to 5.0 | −1.1 to 1.4 |
| High-spending, high-growth (n=60) | −302 | −1426 to 82 | −431 to −123 | −3.0 | −14.6 to 1.0 | −3.9 to −1.2 |
| Pioneer ACO Service Areas (n=32) | −67 | −493 to 285 | −116 to 11 | −0.6 | −4.6 to 3.5 | −1.3 to 0.1 |
Hospital-referral regions (HRRs) were classified by local Medicare spending levels in 2008 and spending growth from 2007 to 2008, relative to national mean spending in 2008 and mean spending growth from 2007 to 2008. For each area, spending targets for 2008 were calculated according to the Pioneer ACO methods and compared with actual local spending in 2008. Using 2008 as an example performance year and 2005 through 2007 as the baseline period, we calculated baseline spending levels for each area by averaging per-beneficiary spending estimates over the 3 baseline years, with baseline spending in years 1 and 2 inflated to year 3 by state-specific growth rates, per the Pioneer methods. To obtain spending targets, we added to the local baseline 50% of the national increase from 2007 to 2008 in average per-beneficiary Medicare spending plus 50% of the product of the local benchmark spending level and the relative growth rate of average national per-beneficiary Medicare spending. We subtracted actual local spending in 2008 from this target to express favorability in absolute terms (dollars per beneficiary) and divided this difference by actual local spending in 2008 to express favorability in relative terms (percentage deviation from 2008 spending). Positive values indicate targets were above actual spending (favorable), and negative values indicate targets were below actual spending (unfavorable). For Pioneer ACO service areas spanning multiple HRRs, we averaged favorability across HRRs weighted by the number of Medicare beneficiaries they contained.