A Taxonomy of Accountable Care Organizations for Policy and Practice

Shortell, Stephen M.; Wu, Frances M.; Lewis, Valerie A.; Colla, Carrie H.; Fisher, Elliott S.

doi:10.1111/1475-6773.12234

Cited by 86 publications

(99 citation statements)

References 33 publications

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“…Moreover, others have suggested that subspecialists may be most prevalent in larger ACOs and/or ACOs formed from existing integrated delivery systems. 17,18 Our findings generally support this hypothesis with empirical evidence demonstrating that MSSP ACOs with participating urologists are larger organizations, in terms of both beneficiaries and providers, than ACOs not formally involving urologists.…”

Section: Commentsupporting

confidence: 75%

Urologist Participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs)

Hawken

Herrel

Ellimoottil

et al. 2016

Urology

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Structured Abstract Objectives To understand the current role of urologists in Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) and the organizational characteristics of ACOs with participating urologists. Methods Using 2012–2013 Medicare data and the National Provider Identifier (NPI) Database, we classified each urologist in the U.S. and Puerto Rico as either an MSSP ACO-participant or non-participating provider. We then examined the distribution of ACO-participating urologists across the U.S. and among the first 220 MSSP ACOs. We also compared the characteristics of ACOs with and without participating urologists. Results Among 11,084 identified urologists, 1,118 (10%) were MSSP ACO-participants. ACO-participating urologists practiced more frequently in the Northeast and Midwest (p<0.001), and were more commonly female (10% vs. 8%, p=0.003). At an organizational level, only 110 (50%) of the initial MSSP ACOs included at least one urologist; among this group, the number of participating urologists ranged from 1 to 55. ACOs with one or more participating urologist were larger organizations, with respect to both the number of assigned beneficiaries and the number of providers per 1,000 beneficiaries (p<0.001 for each comparison). The patient populations served by ACOs with and without urologists were similar (p>0.05 for each comparison). Conclusions A modest percentage of urologists participate in MSSP ACOs, although many of these organizations still lack any formal involvement by urological surgeons. Without such participation, improving the coordination, quality, and cost of urologic care for Medicare beneficiaries may be more challenging.

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Section: Commentsupporting

confidence: 75%

Urologist Participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs)

Hawken

Herrel

Ellimoottil

et al. 2016

Urology

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“…8 By holding groups of providers jointly responsible for cost and quality outcomes, the ACO programs attempt to increase coordination of care, reduce unnecessary spending, and improve quality. Beginning in 2012, groups of hospitals, physicians, and other health care providers voluntarily choose to be part of an ACO.…”

Section: Methodsmentioning

confidence: 99%

Association Between Hospitals’ Engagement in Value-Based Reforms and Readmission Reduction in the Hospital Readmission Reduction Program

et al. 2017

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IMPORTANCE Medicare is experimenting with numerous concurrent reforms aimed at improving quality and value for hospitals. It is unclear if these myriad reforms are mutually reinforcing or in conflict with each other. OBJECTIVE To evaluate whether hospital participation in voluntary value-based reforms was associated with greater improvement under Medicare's Hospital Readmission Reduction Program (HRRP). DESIGN, SETTING, AND PARTICIPANTS Retrospective, longitudinal study using publicly available national data from Hospital Compare on hospital readmissions for 2837 hospitals from 2008 to 2015. We assessed hospital participation in 3 voluntary value-based reforms: Meaningful Use of Electronic Health Records; the Bundled Payment for Care Initiative episode-based payment program (BPCI); and Medicare's Pioneer and Shared Savings accountable care organization (ACO) programs. We used an interrupted time series design to test whether hospitals' time-varying participation in these value-based reforms was associated with greater improvement in Medicare's HRRP.MAIN OUTCOMES AND MEASURES Thirty-day risk standardized readmission rates for acute myocardial infarction (AMI), heart failure, and pneumonia. RESULTS Among the 2837 hospitals in this study, participation in value-based reforms varied considerably over the study period. In 2010, no hospitals were participating in the meaningful use, ACO, or BPCI programs. By 2015, only 56 hospitals were not participating in at least 1 of these programs. Among hospitals that did not participate in any voluntary reforms, the association between the HRRP and 30-day readmission was −0.76 percentage points for AMI (95% CI, −0.93 to −0.60), −1.30 percentage points for heart failure (95% CI, −1.47 to −1.13), and −0.82 percentage points for pneumonia (95% CI, −0.97 to −0.67). Participation in the meaningful use program alone was associated with an additional change in 30-day readmissions of −0.78 percentage points for AMI (95% CI, −0.89 to −0.67), −0.97 percentage points for heart failure (95% CI, −1.08 to −0.86), and −0.56 percentage points for pneumonia (95% CI, −0.65 to −0.47). Participation in ACO programs alone was associated with an additional change in 30-day readmissions of −0.94 percentage points for AMI (95% CI, −1.29 to −0.59), −0.83 percentage points for heart failure (95% CI, −1.26 to −0.41), and −0.59 percentage points for pneumonia (95% CI, −1.00 to −0.18). Participation in multiple reforms led to greater improvement: participation in all 3 programs was associated with an additional change in 30-day readmissions of −1.27 percentage points for AMI (95% CI, −1.58 to −0.97), −1.64 percentage points for heart failure (95% CI, −2.02 to −1.26), and −1.05 percentage points for pneumonia (95% CI, −1.32 to −0.78).CONCLUSIONS AND RELEVANCE Hospital participation in voluntary value-based reforms was associated with greater reductions in readmissions. Our findings lend support for Medicare's multipronged strategy to improve hospital quality and value.

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“…For instance, in the U.S., community-based health and human services are often delivered by networks of independent providers [15]. Additionally, accountable care organisations which can be found in the U.S., but also in countries like Germany, involve inter-organisational collaboration [1617]. The British NHS has experimented with the integration of care through inter-organisational collaboration since the 1990s [8], as have the Nordic countries [18] and the Netherlands [8].…”

Section: Introductionmentioning

confidence: 99%

Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review

2018

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Introduction:In recent years, inter-organisational collaboration between healthcare organisations has become of increasingly vital importance in order to improve the integration of health service delivery. However, different barriers reported in academic literature seem to hinder the formation and development of such collaboration.Theory and methods:This systematic literature review of forty studies summarises and categorises the barriers to integrated care in inter-organisational settings as reported in previous studies. It analyses how these barriers operate.Results:Within these studies, twenty types of barriers have been identified and then categorised in six groups (barriers related to administration and regulation, barriers related to funding, barriers related to the inter-organisational domain, barriers related to the organisational domain, barriers related to service delivery, and barriers related to clinical practices). Not all of these barriers emerge passively, some are set up intentionally. They are not only context-specific, but are also often related and influence each other.Discussion and conclusion:The compilation of these results allows for a better understanding of the characteristics and reasons for the occurrence of barriers that impede collaboration aiming for the integration of care, not only for researchers but also for practitioners. It can help to explain and counteract the slow progress and limited efficiency and effectiveness of some of the inter-organisational collaboration in healthcare settings.

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A Taxonomy of Accountable Care Organizations for Policy and Practice

Abstract: ACOs can be characterized into three distinct clusters. The taxonomy provides a framework for assessing performance, for targeting technical assistance, and for diagnosing potential antitrust violations.

Cited by 86 publications

References 33 publications

Urologist Participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs)

Urologist Participation in Medicare Shared Savings Program Accountable Care Organizations (ACOs)

Association Between Hospitals’ Engagement in Value-Based Reforms and Readmission Reduction in the Hospital Readmission Reduction Program

Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review

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