September 20, 2019


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Last week, CMS published the second year evaluation of the ACO Investment Model (AIM).  AIM provided two years of upfront funds to smaller rural accountable care organizations venturing into value-based payment. The results have been exceptional. In its second year, AIM included 3727 primary care practitioners, 700 specialists, and 680 health care facilities, including critical access hospitals. The program reached 470,129 Medicare beneficiaries.  

AIM is proving that rural providers can save money for Medicare without sacrificing quality. The small, rural AIM ACOs reduced Medicare spending by $36.94 per beneficiary per month in year two, outpacing even the strong results from the first year. Several categories of spending continued to see reductions. Inpatient hospital expenses were lowered 3.4%, with outpatient spending going down 4.4% and skilled nursing facility spending dropping 6.6%. AIM ACOs have earned enough shared savings to pay back $37 million of the $96 million in start-up loans by the second year of the program. 

AIM ACOs are also outperforming similar Shared Savings program ACOs outside of AIM. The first-year evaluation, released last year, showed that AIM ACOs saved more money than other programs that required more downside risk, like the Next Generation or Pioneer ACO programs. The second-year numbers continue that trend. 

Caravan’s Role 

Caravan Health is proud to be the national leader in bringing together rural health systems to implement delivery system reform. Caravan helped organize and launch 21 of the 41 small, rural AIM ACOs – ACOs that account for more than half the total savings. The report quotes a Caravan partner, saying, “It’s been critical to have those funds available to us and of course, to have an organization like Caravan that can help guide us in the right direction as we try to implement as well.” 

What’s Next? 

Rural health advocates are eagerly awaiting the details of a new rural value-based payment model from CMS. The details of AIM’s success make a strong case for AIM 2.0. A few highlights: 

  • AIM fulfilled its goal of getting smaller, rural ACOs to jump into value-based payment: 63% of AIM ACOs would not have participated without AIM funds.  

  • AIM ACOs like the program and want to stick with it: 63% of AIM ACOs plan to continue in the program.  

  • AIM ACOs are still on the fence about jumping into two-sided risk: only 4 of the AIM ACOs are planning to make the transition.  

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