Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries

Abstract

IMPORTANCE-Accountable care contracts hold physician groups financially responsible for the quality and cost of health care delivered to patients. Focusing on clinically vulnerable patients, those with serious conditions who are responsible for the greatest proportion of spending, may result in the largest effects on both patient outcomes and financial rewards for participating physician groups.OBJECTIVE-To estimate the effect of Medicare accountable care organization (ACO) contracts on spending and high-cost institutional use for all Medicare beneficiaries and for clinically vulnerable beneficiaries. DESIGN, SETTING, AND PARTICIPANTS-For this cohort study, 2 study populations were defined: the overall Medicare population and the clinically vulnerable subgroup of Medicare beneficiaries. The overall Medicare population was based on a random 40% sample drawn from

Can accountable care organisations really improve the English NHS? Lessons from the United States

“…ACOs in the Medicare system (government insurance for older people and people with disabilities) have achieved small reductions in spending compared with non-ACOs but only recently started to deliver savings to the government 1314. Savings have often been made in care for complex patients and use of institutional care 15. Medicare ACOs have been associated with improvements in patient experience and some other quality measures, though performance against some quality indicators has not improved 16.…”

Medicare ACO Program Savings Not Tied To Preventable Hospitalizations Or Concentrated Among High-Risk Patients

“…5,11 Reductions in inpatient spending for ACO patients have been proportionally smaller, 11 and several studies through 2013 found minimal or no reductions in hospitalizations for ambulatory care-sensitive conditions (ACSCs). 3–5 For high-risk patients with multiple conditions, one study found greater absolute reductions in hospitalizations in 2013 than for lower-risk patients but similar relative reductions. 3 This pattern would be expected from interventions that reduce hospitalizations for all patients proportional to their risk of hospitalization, and not necessarily from interventions focused exclusively on high-risk patients.…”

“…3–5 For high-risk patients with multiple conditions, one study found greater absolute reductions in hospitalizations in 2013 than for lower-risk patients but similar relative reductions. 3 This pattern would be expected from interventions that reduce hospitalizations for all patients proportional to their risk of hospitalization, and not necessarily from interventions focused exclusively on high-risk patients.…”

The Affordable Care Act and Cancer Care Delivery

“…In one study of both the Medicare Shared Savings and Pioneer programs, researchers demonstrated that ACO enrollment was associated with modest reductions in health care spending, hospitalizations, and ED visits, among all patients. 17 Savings were magnified in a subgroup of patients with multiple chronic conditions, one quarter of whom carried a cancer diagnosis. Reductions in spending for patients with cancer did not appear to differ from spending reductions for patients with other chronic conditions.…”