Accountable Care Organizations in the United States: Market and Demographic Factors Associated with Formation

Lewis, Valerie A.; Colla, Carrie H.; Carluzzo, Kathleen L.; Kler, S

doi:10.1111/1475-6773.12102

Cited by 89 publications

(105 citation statements)

References 24 publications

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“…There are 306 HHRs in the U.S., compared to 3141 counties. Lewis et al (2013) use Hospital Service Areas (HSAs) also from the Dartmouth Atlas. HSAs are roughly comparable to counties.…”

Section: Precursors Of Acos: Hmos and Physician-hospital Organizationmentioning

confidence: 99%

Market Power, Transactions Costs, and the Entry of Accountable Care Organizations in Health Care

et al. 2015

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ACOs were promoted in the 2010 Patient Protection and Affordable Care Act (ACA) to incentivize integrated care and cost control. Because they involve vertical and horizontal collaboration, ACOs also have the potential to harm competition. In this paper, we analyze ACO entry and formation patterns with the use of a unique, proprietary database that includes public (Medicare) and private ACOs. We estimate an empirical model that explains county-level ACO entry as a function of: physician, hospital, and insurance market structure; demographics; and other economic and regulatory factors. We find that physician concentration by organization has little effect. In contrast, physician concentration by geographic site-which is a new measure of locational concentration of physicians-discourages ACO entry. Hospital concentration generally has a negative effect. HMO penetration is a strong predictor of ACO entry, while physician-hospital organizations have little effect. Small markets discourage entry, which suggests economies of scale for ACOs. Predictors of public and private ACO entry are different. State regulations of nursing and the corporate practice of medicine have little effect.

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“…There are 306 HHRs in the U.S., compared to 3141 counties. Lewis et al (2013) use Hospital Service Areas (HSAs) also from the Dartmouth Atlas. HSAs are roughly comparable to counties.…”

Section: Precursors Of Acos: Hmos and Physician-hospital Organizationmentioning

confidence: 99%

Market Power, Transactions Costs, and the Entry of Accountable Care Organizations in Health Care

et al. 2015

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“…16,74,75 Notwithstanding the $11 billion the ACA committed for CHC expansion over 2010-2015, 34 the continuing financial challenges faced by safety-net providers may compromise access in low-income communities and undermine the quality of care by thwarting these institutions' ability to innovate in service delivery, improve quality, and participate in accountable care organizations. 35,36,76 Bolstering the financial viability of safety-net providers via such key mechanisms as ensuring adequate federal funding for CHCs as well as reforming Medicaid payments, which together make nearly 80 % of these facilities' revenue, 16 will be critical for securing more equitable health care for disadvantaged communities. 77,78 More broadly, several relevant empirical questions remain key to understanding the mechanisms linking neighborhood socioeconomic conditions and access to health care.…”

Section: Discussionmentioning

confidence: 99%

“…Several ACA provisions seek to improve primary care access and delivery, such as by increasing the primary care workforce, expanding community health centers, encouraging the formation of accountable care organizations, and promoting changes in provider payments and incentives. 34 The effectiveness of these provisions will likely vary across areas of different SES, given baseline variations in provider supply and capacity 35,36 and in community demographic characteristics and social organization. 37 In this study, we used time-series cross-sectional data from the Philadelphia region to (1) estimate the associations of neighborhood SES with self-reported access to usual sources of care, after adjusting for individual and area-level factors known to be associated with access; and (2) assess whether these associations varied over the decade of 2002-2012.…”

mentioning

confidence: 99%

Neighborhood Socioeconomic Status and Primary Health Care: Usual Points of Access and Temporal Trends in a Major US Urban Area

2016

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Neighborhood socioeconomic status (SES), an overall marker of neighborhood conditions, may determine residents' access to health care, independently of their own individual characteristics. It remains unclear, however, how the distinct settings where individuals seek care vary by neighborhood SES, particularly in US urban areas. With existing literature being relatively old, revealing how these associations might have changed in recent years is also timely in this US health care reform era. Using data on the Philadelphia region from 2002 to 2012, we performed multilevel analysis to examine the associations of neighborhood SES (measured as census tract median household income) with access to usual sources of primary care (physician offices, community health centers, and hospital outpatient clinics). We found no evidence that residence in a low-income (versus high-income) neighborhood was associated with poorer overall access. However, low-income neighborhood residence was associated with less reliance on physician offices [−4.40 percentage points; 95 % confidence intervals (CI) −5.80, −3.00] and greater reliance on the safety net provided by health centers [2.08; 95 % CI 1.42, 2.75] and outpatient clinics [1.61; 95 % CI 0.97, 2.26]. These patterns largely persisted over the 10 years investigated. These findings suggest that safety-net providers have continued to play an important role in ensuring access to primary care in urban, low-income communities, further underscoring the importance of supporting a strong safety net to ensure equitable access to care regardless of place of residence.

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“…In this study, we investigated this association by adding claims-based quality measures of diabetes care. 25 We recognized that HSA and institution are contextual factors offering limited options for GME reform. So we also explored limited compositional factors-sponsoring institution characteristics-for potential training-outcome differences that might offer more specific options for GME reform.…”

mentioning

confidence: 99%

The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice

Phillips¹,

Petterson

Bazemore

et al. 2017

Ann Fam Med

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PURPOSE Medicare beneficiary spending patterns reflect those of the 306 Hospital Referral Regions where physicians train, but whether this holds true for smaller areas or for quality is uncertain. This study assesses whether cost and quality imprinting can be detected within the 3,436 Hospital Service Areas (HSAs), 82.4 percent of which have only 1 teaching hospital, and whether sponsoring institution characteristics are associated. METHODSWe conducted a secondary, multi-level, multivariable analysis of 2011 Medicare claims and American Medical Association Masterfile data for a random, nationally representative sample of family physicians and general internists who completed residency between 1992 and 2010 and had more than 40 Medicare patients (3,075 physicians providing care to 503,109 beneficiaries). Practice and training locations were matched with Dartmouth Atlas HSAs and categorized into low-, average-, and high-cost spending groups. Practice and training HSAs were assessed for differences in 4 diabetes quality measures. Institutional characteristics included training volume and percentage of graduates in rural practice and primary care. RESULTSThe unadjusted, annual, per-beneficiary spending difference between physicians trained in high-and low-cost HSAs was $1,644 (95% CI, $1,253-$2,034), and the difference remained significant after controlling for patient and physician characteristics. No significant relationship was found for diabetes quality measures. General internists were significantly more likely than family physicians to train in high-cost HSAs. Institutions with more graduates in rural practice and primary care produced lower-spending physicians.CONCLUSIONS The "imprint" of training spending patterns on physicians is strong and enduring, without discernible quality effects, and, along with identified institutional features, supports measures and policy options for improved graduate medical education outcomes. Ann Fam Med 2017;15:140-148. https://doi.org/10.1370/afm.2044. INTRODUCTIONP ublic and private payers have embraced value-based health care, and are marching aggressively toward the Triple Aim-better health, better care, and lower costs.1 Simultaneously, the National Academy of Medicine, The Josiah Macy Jr Foundation, and others are calling for greater accountability for more than $15 billion currently spent on Graduate Medical Education (GME), and for more strategic allocation of GME funding.2-8 Most research supporting accountability measures and reform options has focused on the specialties and distribution of graduates, but our recent study exploring the relationship between training and future practice costs found that physician-associated Medicare costs were highly correlated with those of their the physicians ' Hospital Referral Regions (HRR). 9 Educational imprinting is the idea that learners model witnessed behaviors and beliefs, sometimes despite what they are taught, and GME is not immune. These studies demonstrate important relationships between training and subsequent...

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Accountable Care Organizations in the United States: Market and Demographic Factors Associated with Formation

Abstract: Much of the US population resides in areas where ACOs have been established. ACO formation has taken place where it may be easier to meet quality and cost targets. Wider adoption of the ACO model may require tailoring to local context.

Cited by 89 publications

References 24 publications

Market Power, Transactions Costs, and the Entry of Accountable Care Organizations in Health Care

Market Power, Transactions Costs, and the Entry of Accountable Care Organizations in Health Care

Neighborhood Socioeconomic Status and Primary Health Care: Usual Points of Access and Temporal Trends in a Major US Urban Area

The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice

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