The Design And Application Of Shared Savings Programs: Lessons From Early Adopters

Weissman, Joel S.; Bailit, Michael H.; D’Andrea, Guy; Rosenthal, Meredith B.

doi:10.1377/hlthaff.2012.0383

Cited by 16 publications

(10 citation statements)

References 4 publications

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“…Although ACO initiatives are relatively new, early evidence suggests that most health care organizations struggle to manage populations of patients effectively, and the results of recent ACO initiatives in terms of cost savings are mixed. 8…”

Section: Accountable Care Organizationsmentioning

confidence: 99%

The Changing Role of Ancillary Health Care Service Providers: An Evaluation of Health Diagnostic Laboratory, Inc.

Thompson

Varvel

Vörös

et al. 2014

Population Health Management

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In an effort to reduce cost and improve quality, health care payers have enacted a number of incentives to motivate providers to focus their efforts on achieving better clinical outcomes and reducing the prevalence and progression of disease. In response to these incentives, providers are entering into new arrangements such as accountable care organizations and patient-centered medical homes to redesign delivery processes and achieve quality and cost objectives. This article reports the results of a study designed to evaluate the impact on cost and quality of care resulting from services provided by Health Diagnostic Laboratory, Inc., a clinical laboratory with a comprehensive care model. The results show that patients who utilized these laboratory services experienced lower total cost of care (23% reduction, P<0.01) and improved lipid profiles during the follow-up period. Total cost reductions were related to cost reductions found in both inpatient and ambulatory care. These findings suggest that accountable care organizations, patient-centered medical homes, and other groups entering shared savings initiatives should consider the potential role ancillary service providers with comprehensive care models can play in the delivery of integrated care.

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Section: Accountable Care Organizationsmentioning

confidence: 99%

The Changing Role of Ancillary Health Care Service Providers: An Evaluation of Health Diagnostic Laboratory, Inc.

Thompson

Varvel

Vörös

et al. 2014

Population Health Management

View full text Add to dashboard Cite

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“…This will depend on providers’ and patients’ treatment choices, but it will also depend on the ability of device makers and manufacturers of tools, scanners, and other technologies to focus on innovations that are high value. As lessons from early global or bundled payment systems amass, 5556 an understanding of the mechanisms by which spending is reduced will be as important to policymakers as that it can be reduced at all.…”

Section: Discussionmentioning

confidence: 99%

Global budgets and technology-intensive medical services

et al. 2013

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Background In 2009-2010, Blue Cross Blue Shield of Massachusetts entered into global payment contracts (the Alternative Quality contract, AQC) with 11 provider organizations. We evaluated the impact of the AQC on spending and utilization of several categories of medical technologies, including one considered high value (colonoscopies) and three that include services that may be overused in some situations (cardiovascular, imaging, and orthopedic services). Methods Approximately 420,000 unique enrollees in 2009 and 180,000 in 2010 were linked to primary care physicians whose organizations joined the AQC. Using three years of pre-intervention data and a large control group, we analyzed changes in utilization and spending associated with the AQC with a propensity-weighted difference-in-differences approach adjusting for enrollee demographics, health status, secular trends, and cost-sharing. Results In the 2009 AQC cohort, total volume of colonoscopies increased 5.2 percent (p=0.04) in the first two years of the contract relative to control. The contract was associated with varied changes in volume for cardiovascular and imaging services, but total spending on cardiovascular services in the first two years decreased by 7.4% (p=0.02) while total spending on imaging services decreased by 6.1% (p<0.001) relative to control. In addition to lower utilization of higher-priced services, these decreases were also attributable to shifting care to lower-priced providers. No effect was found in orthopedics. Conclusions As one example of a large-scale global payment initiative, the AQC was associated with higher use of colonoscopies. Among several categories of services whose value may be controversial, the contract generally shifted volume to lower-priced facilities or services.

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“…More recently some PCMH initiatives have integrated responsibility for total cost of care through "shared savings" programs, blurring the line between PCMH initiatives and ACOs. 22 In general, however, there are several important distinctions between shared savings programs aimed at ACOs and those aimed at PCMHs. First, under PCMHs, the primary care practices receive the shared savings, whereas under ACOs the organization has flexibility in determining how shared savings payments are distributed, and may not necessarily direct these payments to support enhanced primary care or reward primary care practices' efforts to attain ACO goals (although some of them undoubtedly will).…”

Section: Scope Of Accountabilitymentioning

confidence: 99%

Structuring Payment to Medical Homes After the Affordable Care Act

et al. 2014

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The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.

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The Design And Application Of Shared Savings Programs: Lessons From Early Adopters

Cited by 16 publications

References 4 publications

The Changing Role of Ancillary Health Care Service Providers: An Evaluation of Health Diagnostic Laboratory, Inc.

The Changing Role of Ancillary Health Care Service Providers: An Evaluation of Health Diagnostic Laboratory, Inc.

Global budgets and technology-intensive medical services

Structuring Payment to Medical Homes After the Affordable Care Act

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