Medicare Accountable Care Organizations of Diverse Structures Achieve Comparable Quality and Cost Performance

Comfort, Leeann N.; Shortell, Stephen M.; Rodríguez, Hector P.; Colla, Carrie H.

doi:10.1111/1475-6773.12829

Cited by 16 publications

(18 citation statements)

References 22 publications

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“…We developed the survey instrument through an extensive literature review and examination of prior survey instruments, 22‐33 domain and survey expert interviews, and cognitive testing.…”

Section: Methodsmentioning

confidence: 99%

Care integration within and outside health system boundaries

Singer

Sinaiko

Tietschert

et al. 2020

Health Services Research

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Objective Examine care integration—efforts to unify disparate parts of health care organizations to generate synergy across activities occurring within and between them—to understand whether and at which organizational level health systems impact care quality and staff experience. Data Sources Surveys administered to one practice manager (56/59) and up to 26 staff (828/1360) in 59 practice sites within 24 physician organizations within 17 health systems in four states (2017‐2019). Study Design We developed manager and staff surveys to collect data on organizational, social, and clinical process integration, at four organizational levels: practice site, physician organization, health system, and outside health systems. We analyzed data using descriptive statistics and regression. Principal Findings Managers and staff perceived opportunity for improvement across most types of care integration and organizational levels. Managers/staff perceived little variation in care integration across health systems. They perceived better care integration within practice sites than within physician organizations, health systems, and outside health systems—up to 38 percentage points (pp) lower (P < .001) outside health systems compared to within practice sites. Of nine clinical process integration measures, one standard deviation (SD) (7.2‐pp) increase in use of evidence‐based care related to 6.4‐pp and 8.9‐pp increases in perceived quality of care by practice sites and health systems, respectively, and a 4.5‐pp increase in staff job satisfaction; one SD (9.7‐pp) increase in integration of social services and community resources related to a 7.0‐pp increase in perceived quality of care by health systems; one SD (6.9‐pp) increase in patient engagement related to a 6.4‐pp increase in job satisfaction and a 4.6‐pp decrease in burnout; and one SD (10.6‐pp) increase in integration of diabetic eye examinations related to a 5.5‐pp increase in job satisfaction (all P < .05). Conclusions Measures of clinical process integration related to higher staff ratings of quality and experience. Action is needed to improve care integration within and outside health systems.

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“…We developed the survey instrument through an extensive literature review and examination of prior survey instruments, 22‐33 domain and survey expert interviews, and cognitive testing.…”

Section: Methodsmentioning

confidence: 99%

Care integration within and outside health system boundaries

Singer

Sinaiko

Tietschert

et al. 2020

Health Services Research

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show abstract

“…The most recent evidence finds no difference in quality or spending by ACO type (for example, large integrated systems versus smaller physician led ACOs) 21. Greater variation can be found within types than between them, pointing towards differences in leadership, culture, and related factors as alternative explanations for ACO performance.…”

Section: How Are Acos Performing?mentioning

confidence: 99%

“…Results of the two programmes are similar. Broader evidence also suggests that organisational type is not associated with ACO outcomes 21. Internal organisational factors more to do with leadership, culture, and management—such as capabilities to redesign services or the ability to overcome professional inertia—offer alternative explanations for ACO performance 1323…”

Section: Lessons For the English Nhsmentioning

confidence: 99%

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

Alderwick

Shortell

Briggs

2018

BMJ

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“…ACOs’ objectives are to improve quality of care without raising expenditures or reduce expenditures while maintaining quality or care. Early evidence on ACOs’ ability to achieve these objectives has been mixed (Busch, Huskamp, & McWilliams, 2016; Comfort, Shortell, Rodriguez, & Colla, 2018; Kaufman, Spivack, Stearns, Song, & O’Brien, 2017; McWilliams, Hatfield, Chernew, Landon, & Schwartz, 2016).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Markets and Patients Served by ESRD Seamless Care Organizations

et al. 2019

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Under the Comprehensive End-stage Renal Disease (ESRD) Care (CEC) Model, dialysis facilities and nephrologists form ESRD Seamless Care Organizations (ESCOs) to deliver high value care. This study compared the characteristics of patients and markets served and unserved by CEC and assessed its generalizability. ESCOs operated in 65 of 384 markets. ESCO markets were larger than non-ESCO markets, had fewer White patients, higher household income, and higher Medicare spending per patient. Patients in ESCOs were similar to eligible nonaligned patients in age and sex but differed in race/ethnicity and were more often treated in an urban area; comorbidity prevalence differed modestly. CEC is available to a meaningful share of the dialysis population and relatively few dialysis patients resided in a market where no provider could meet the participation threshold, so market size may not be the primary barrier for potential new participants in CEC or future kidney care models.

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Medicare Accountable Care Organizations of Diverse Structures Achieve Comparable Quality and Cost Performance

Cited by 16 publications

References 22 publications

Care integration within and outside health system boundaries

Care integration within and outside health system boundaries

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

Characteristics of Markets and Patients Served by ESRD Seamless Care Organizations

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