Accountable care organizations in Texas were responsible for a large cut of the dollars saved by the Medicare Shared Savings Program thus far. Not all Texas ACOs saved money, but the ones that did indicate that accountable care could have staying power in unexpected places.

It's easy to look at Memorial Hermann's big numbers and assign it all the credit. The Houston-based ACO saved nearly $58 million in its first year, good for shared savings payments of $28.3 million. It was the only ACO to save more than $30 million except Florida's Palm Beach Accountable Care Organization.  Other pockets of coordinated care have subsisted in Texas since the 1990s HMO bust but these are the exception, not the rule. Kelsey-Seybold Clinic in Houston was among the nation's first ACOs certified by the NCQA. Scott & White, now merged with the former Baylor Health Care System, was a pioneer for vertically integrated care and anchored one of the state's lowest cost Medicare regions.

But it's elsewhere in the Lone Star State that regions not known for integrated or coordinated care have shown significant strides. McAllen is home to two MSSP ACOs that have saved money: RGV ACO Health Providers at $20 million and Rio Grande Valley Health Alliance at $6 million. Both in the Advanced Payment track (they receive upfront payments that will be paid back from future shared savings).

McAllen may sound familiar. The subject of a 2009 article in The New Yorker, the town became the epicenter of the U.S.'s broken healthcare system with inordinately high Medicare costs and uncoordinated care.  The region's poor, predominantly Hispanic population, the nation's highest obesity rate, and a low rate of physicians make McAllen's $26 million ACO take all the more surprising.

McAllen's Rio Grande Valley ACOs aren't alone. Amarillo Legacy Medical ACO saved $4.88 million, receiving $2.34 million in bonus payments. Houston-based Physicians ACO saved $12 million but received no savings. Results are pending for Essential Care Partners and Essential Care Partners II, both coalitions of community health clinics.

So have ACOs really made a difference in Texas? These results still feel preliminary. For many ACOs, savings could come from tackling easy expenses like emphasizing generic utilization, increasing required screenings for chronically ill beneficiaries or cutting hospital readmissions. In states where capitation and coordinated care and capitation are widespread, it might be harder to achieve. But in areas where such care never existed, early returns from South Texas signal that ACOs might have established a foundation.

Follow Bill Melville on Twitter @BillMelvilleDRG

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