The Impact of Simultaneous Hospital Participation in Accountable Care Organizations and Bundled Payments on Episode Outcomes

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Joshua M. Liao ◽  
Erkuan Wang ◽  
Ulysses Isidro ◽  
Amol S. Navathe
Keyword(s):  
Accountable Care Organizations ◽  
Accountable Care ◽  
Bundled Payments ◽  
The Impact

scholarly journals Post-Acute Care for Medicare Beneficiaries in Accountable Care Organizations

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 19-19
Author(s):  
Erin Colligan ◽  
Brittany Branand
Keyword(s):  
Acute Care ◽  
Inpatient Rehabilitation ◽  
Cost Of Care ◽  
Accountable Care Organizations ◽  
Care Utilization ◽  
Accountable Care ◽  
Total Cost ◽  
Transitions In Care ◽  
The Impact ◽  
Post Acute Care

Abstract Post-acute care (PAC) is a component of health-care utilization and spending that is subject to the discretion of providers. Prior research has demonstrated that Accountable Care Organizations (ACOs) recognize PAC as a logical target for increased efficiency and cost savings. As part of the evaluation of the Centers for Medicare & Medicaid Services (CMS) Next Generation ACO (NGACO) Model, we investigated NGACOs’ approaches to PAC services and the impact of these efforts on utilization and cost using a mixed-methods study design. We conducted interviews and surveys with NGACO leadership and providers and performed a difference-in-differences analysis of utilization and spending based on Medicare claims data. We found that NGACOs focused specifically on establishing partnerships with skilled nursing facilities (SNF) to facilitate transitions in care by establishing new channels of communication, sharing performance data, embedding staff in SNFs, and (in some cases) sharing financial risk. We observed a statistically significant decrease in SNF spending, a trend toward fewer SNF days, and statistically significantly lower expenditures for other PAC settings (e.g., inpatient rehabilitation and long-term acute care facilities). These findings suggest that NGACOs have contributed to improving transitions in care and diverting beneficiaries from intensive PAC settings. Nonetheless, the reduction in PAC spending alone did not translate to a decline in total cost of care. Future ACOs may need to expand their focus to the inpatient utilization and spending that precedes PAC in order to impact total cost of care.

scholarly journals Barriers and Facilitators To Implementation and Sustainment of 17 New Medicaid Accountable Care Organizations in Massachusetts: A Study Protocol

2020 ◽  
Author(s):  
Sarah L. Goff ◽  
Deborah Gurewich ◽  
Matthew Alcusky ◽  
Aparna G. Kachoria ◽  
Joanne Nicholson ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Large Scale ◽  
Healthcare Delivery ◽  
Accountable Care Organizations ◽  
Barriers And Facilitators ◽  
Accountable Care ◽  
Community Partner ◽  
Number Of Patients ◽  
The Impact

Abstract Background: Accountable care organizations (ACOs) utilize value-based payment models, which incentivize quality of care and cost reduction through shared financial risk contracts for payers and providers. The impact of ACOs on cost and quality has been mixed for Medicare and commercial insurers, but the model has yet to be extensively tested in the Medicaid system, which insures a large number of patients in socioeconomically disadvantaged populations. Additionally, despite substantial heterogeneity in ACO models, the majority of ACO studies have examined ACO outcomes without exploring the potential impact of implementation and sustainment on these outcomes. Understanding barriers and facilitators to implementation and sustainment of Medicaid ACOs will help to better understand their impact on patient care, outcomes and costs for a vulnerable population.Methods and Design: The state of Massachusetts (MA) approved 17 new Medicaid ACOs and associated Community Partner (CP) organizations in 2018 as part of a large-scale pragmatic experiment in healthcare reform. The new ACOs will receive $1.8 billion dollars in state and federal funds over five years aimed at supporting implementation and sustainment the new model. This study aims to identify barriers and facilitators to implementation and sustainment of activities supported by these funds using the Consolidated Framework for Implementation Science (CFIR) as a guiding framework through: (1) review of administrative documents classify organizational characteristics of the ACOs and CPs including plans for innovation; (2) key informant interviews (KII) with ACO and CP leaders, governmental administrative leaders, and patients; (3) case studies of ACOs and CPs; and (4) a survey of front-line providers and staff in the ACOs and CPs. Descriptive quantitative statistics will be used to analyze document and survey data and framework analysis will be used to analyze KII and site visit data.Discussion: The new Medicaid ACOs in MA aim to improve care integration, quality of care, and patient experience while reducing costs through innovations in healthcare delivery and payment. Understanding the barriers and facilitators to implementing and sustaining the ACO model will provide critical context for understanding the overall impact of the Medicaid ACO experiment in MA.

scholarly journals Recommended Cancer Screening in Accountable Care Organizations: Trends in Colonoscopy and Mammography in the Medicare Shared Savings Program

2019 ◽  
Vol 15 (6) ◽  
pp. e547-e559 ◽  
Author(s):  
Alexander P. Cole ◽  
Anna Krasnova ◽  
Ashwin Ramaswamy ◽  
Sean A. Fletcher ◽  
David F. Friedlander ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Care Delivery ◽  
Accountable Care Organizations ◽  
Screening Tests ◽  
Accountable Care ◽  
Difference In Differences ◽  
Significant Difference ◽  
Shared Savings ◽  
Medicare Shared Savings Program ◽  
The Impact

PURPOSE: Accountable care organizations (ACOs) are a delivery and payment model designed to encourage integrated, high-value care. We designed a study to test the association between ACOs and two recommended cancer screening tests, colonoscopy for colorectal cancer and mammography for breast cancer. METHODS: Using the random 20% sample of Medicare claims, beneficiaries were attributed to ACO or non-ACO cohorts on the basis of providers’ enrollment in the Medicare Shared Savings Program. An inverse probability of treatment weighting was used to balance patient characteristics between ACO and non-ACO cohorts. A propensity score–weighted, difference-in-differences analysis was then performed using the same provider groups in 2010—pre-ACO—as a baseline. A secondary analysis for older—nonrecommended—age ranges was performed. RESULTS: Prevalence of colonoscopy in recommended age ranges in ACOs from 2010 to 2014 increased from 15.3% (95% CI, 14.9% to 15.6%) to 17.9% (95% CI, 17.3% to 18.5%). This differed significantly from the change in non-ACOs (difference in differences, 1.2%; P < .001). Among women in ACOs, mammography prevalence rose from 53.7% (95% CI, 53.0% to 54.4%) to 54.9% (95% CI, 54.2% to 55.7%). In contrast to colonoscopy, the difference in mammography prevalence was not significantly different in ACO versus non-ACOs (difference in differences, 0.49%; P < .13). A similar pattern was also observed in older—nonrecommended—age ranges with significant difference in differences (ACO v non-ACO) in colonoscopy, but not mammography. CONCLUSION: The impact of ACOs on cancer screening varies between screening tests. Our results are consistent with a greater effect of ACOs on high-cost, high-complexity screening services, which may be more sensitive to integrated care delivery models.

Impact of Accountable Care Organizations on Utilization, Care, and Outcomes: A Systematic Review

2017 ◽  
Vol 76 (3) ◽  
pp. 255-290 ◽  
Author(s):  
Brystana G. Kaufman ◽  
B. Steven Spivack ◽  
Sally C. Stearns ◽  
Paula H. Song ◽  
Emily C. O’Brien
Keyword(s):  
Service Use ◽  
The United States ◽  
Emergency Department Visits ◽  
Accountable Care Organizations ◽  
Systematic Evaluation ◽  
Accountable Care ◽  
Public And Private ◽  
Outcomes Of Care ◽  
The Impact

Since 2010, more than 900 accountable care organizations (ACOs) have formed payment contracts with public and private insurers in the United States; however, there has not been a systematic evaluation of the evidence studying impacts of ACOs on care and outcomes across payer types. This review evaluates the quality of evidence regarding the association of public and private ACOs with health service use, processes, and outcomes of care. The 42 articles identified studied ACO contracts with Medicare ( N = 24 articles), Medicaid ( N = 5), commercial ( N = 11), and all payers ( N = 2). The most consistent associations between ACO implementation and outcomes across payer types were reduced inpatient use, reduced emergency department visits, and improved measures of preventive care and chronic disease management. The seven studies evaluating patient experience or clinical outcomes of care showed no evidence that ACOs worsen outcomes of care; however, the impact on patient care and outcomes should continue to be monitored.

Organizational Capacity of Hospitals Co-Participating in Accountable Care Organizations and Bundled Payments

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Joshua M. Liao ◽  
Ryan P. Clodfelter ◽  
Jack J. Huang ◽  
Lingmei Zhou ◽  
Jay Bhatt ◽  
...  
Keyword(s):  
Organizational Capacity ◽  
Accountable Care Organizations ◽  
Accountable Care ◽  
Bundled Payments

The impact of accountable care organizations on spine care

2019 ◽  
Vol 31 (1) ◽  
pp. 7-11
Author(s):  
Daniel G. Tobert ◽  
Andrew J. Schoenfeld
Keyword(s):  
Accountable Care Organizations ◽  
Accountable Care ◽  
Spine Care ◽  
The Impact

Population Health: An Old Idea Gets New Attention

2019 ◽  
Vol 34 (5) ◽  
pp. 293-301
Author(s):  
Joanne Kaldy
Keyword(s):  
Medication Management ◽  
Accountable Care Organizations ◽  
Smooth Transition ◽  
Accountable Care ◽  
Bundled Payments ◽  
Avoidable Hospitalizations ◽  
Broad Array ◽  
Health Care Models ◽  
Care Models ◽  
Value Based Care

A focus on patient populations—as opposed to care settings—encompasses a broad array of health care models: accountable care organizations, managed care, bundled payments, and other value-based care medical models. Pharmacists have a key role to play in streamlining medication management within these settings, ensuring a smooth transition as patients move through the care continuum, and preventing avoidable hospitalizations and readmissions.

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