scholarly journals Accountable Care Organizations and Spending for Patients Undergoing Long-Term Dialysis

2020 ◽  
Vol 15 (12) ◽  
pp. 1777-1784
Author(s):  
Shivani Bakre ◽  
John M. Hollingsworth ◽  
Phyllis L. Yan ◽  
Emily J. Lawton ◽  
Richard A. Hirth ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Confidence Interval ◽  
Primary Care Physician ◽  
Accountable Care Organization ◽  
Care Physician ◽  
Accountable Care Organizations ◽  
Care Organization ◽  
Accountable Care

Background and objectivesDespite representing 1% of the population, beneficiaries on long-term dialysis account for over 7% of Medicare’s fee-for-service spending. Because of their focus on care coordination, Accountable Care Organizations may be an effective model to reduce spending inefficiencies for this population. We analyzed Medicare data to examine time trends in long-term dialysis beneficiary alignment to Accountable Care Organizations and differences in spending for those who were Accountable Care Organization aligned versus nonaligned.Design, setting, participants, & measurementsIn this retrospective cohort study, beneficiaries on long-term dialysis between 2009 and 2016 were identified using a 20% random sample of Medicare beneficiaries. Trends in alignment to an Accountable Care Organization were compared with alignment of the general Medicare population from 2012 to 2016. Using an interrupted time series approach, we examined the association between Accountable Care Organization alignment and the primary outcome of total spending for long-term dialysis beneficiaries from prior to Accountable Care Organization implementation (2009–2011) through implementation of the Comprehensive ESRD Care model in October 2015. We fit linear regression models with generalized estimating equations to adjust for patient characteristics.ResultsDuring the study period, 135,152 beneficiaries on long-term dialysis were identified. The percentage of long-term dialysis beneficiaries aligned to an Accountable Care Organization increased from 6% to 23% from 2012 to 2016. In the time series analysis, spending on Accountable Care Organization–aligned beneficiaries was $143 (95% confidence interval, $5 to $282) less per beneficiary-quarter than spending for nonaligned beneficiaries. In analyses stratified by whether beneficiaries received care from a primary care physician, savings by Accountable Care Organization–aligned beneficiaries were limited to those with care by a primary care physician ($235; 95% confidence interval, $73 to $397).ConclusionsThere was a substantial increase in the percentage of long-term dialysis beneficiaries aligned to an Accountable Care Organization from 2012 to 2016. Moreover, in adjusted models, Accountable Care Organization alignment was associated with modest cost savings among long-term dialysis beneficiaries with care by a primary care physician.

impact of a Pharmacy-Led Transitions of Care Program Within a Primary Care-Based Accountable Care Organization

2021 ◽  
Vol 36 (6) ◽  
pp. 311-316
Author(s):  
Tina Joseph ◽  
Genevieve M. Hale ◽  
Cynthia Moreau ◽  
Stephanie L. Kourtakis ◽  
William R. Wolowich
Keyword(s):  
Primary Care ◽  
Primary Outcome ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Program ◽  
Accountable Care Organization ◽  
Transitions Of Care ◽  
Care Organization ◽  
Pharmacy Services ◽  
Accountable Care

OBJECTIVE: To assess the impact of pharmacist-led transitions of care program on 30-day readmission rates in the accountable care organization (ACO) primary care setting. DESIGN: Retrospective cohort study. SETTING: Two primary care provider (PCP) offices with an ACO in South Florida. PATIENTS, PARTICIPANTS: Adult Medicare patients who completed a post-discharge follow-up visit at two primary care offices within an ACO from July to December 2017. INTERVENTIONS: To supplement postdischarge visits with a PCP, the pharmacy services were also provided two days per week with a PCP. The comparator groups were patients who only saw a PCP or those who saw a PCP and pharmacist. MAIN OUTCOME MEASUREMENTS: The primary outcome was hospital readmission or emergency department visit within 30 days. RESULTS: A total of 190 subjects were included. There were 113 patients in the PCP group and 77 patients in the PCP/pharmacist group. There was a reduction in the primary outcome when comparing the PCP-only versus PCP/pharmacist groups (6.2% versus 3.9%; P = 0.74). CONCLUSION: Involving pharmacists in patient transitions of care in the primary care setting may be beneficial as previous studies have demonstrated. Further studies evaluating pharmacy services in emerging health care models are needed in order to most effectively utilize the expertise of the pharmacy team.

Payment Reform for Primary Care Within the Accountable Care Organization

JAMA ◽  
2012 ◽  
Vol 308 (6) ◽  
pp. 577 ◽  
Author(s):  
Allan H. Goroll ◽  
Stephen C. Schoenbaum
Keyword(s):  
Primary Care ◽  
Accountable Care Organization ◽  
Care Organization ◽  
Accountable Care ◽  
Payment Reform

scholarly journals Association of Primary Care Involvement with Death or Hospitalizations for Patients Starting Dialysis

2020 ◽  
Vol 15 (4) ◽  
pp. 521-529 ◽  
Author(s):  
Samuel A. Silver ◽  
Sarah E. Bota ◽  
Eric McArthur ◽  
Kristin K. Clemens ◽  
Ziv Harel ◽  
...  
Keyword(s):  
Primary Care ◽  
Confidence Interval ◽  
Primary Care Physician ◽  
Lower Risk ◽  
Care Physician ◽  
Hazard Ratio ◽  
Dialysis Initiation ◽  
Risk Of Mortality ◽  
Maintenance Dialysis ◽  
Disease Specific

Background and objectivesIt is uncertain whether primary care physician continuity of care associates with a lower risk of death and hospitalization among patients transitioning to maintenance dialysis.Design, setting, participants, & measurementsUsing provincial-linked administrative databases in Ontario, Canada, we conducted a population-based study of incident patients who initiated maintenance dialysis between 2005 and 2014 and survived for at least 90 days. We defined high primary care physician continuity as both a high usual provider of care index (where >75% of primary care physician visits occurred with the same primary care physician) in the 2 years before dialysis (an established measure of primary care physician continuity) and at least one visit with the same primary care physician in the 90 days after dialysis initiation. We used propensity scores to match a group of patients with high and low continuity so that indicators of baseline health were similar. The primary outcome was all-cause mortality, and secondary outcomes included all-cause and disease-specific hospitalizations during the 2 years after maintenance dialysis initiation.ResultsWe identified 19,099 eligible patients. There were 6612 patients with high primary care physician continuity, of whom 6391 (97%) were matched to 6391 patients with low primary care physician continuity. High primary care physician continuity was not associated with a lower risk of mortality (14.5 deaths per 100 person-years versus 15.2 deaths per 100 person-years; hazard ratio, 0.96; 95% confidence interval, 0.89 to 1.02). There was no difference in the rate of all-cause hospitalizations (hazard ratio, 0.96; 95% confidence interval, 0.92 to 1.01), and high primary care physician continuity was not associated with a lower risk of any disease-specific hospitalization, except for those related to diabetes (hazard ratio, 0.88; 95% confidence interval, 0.80 to 0.97).ConclusionsHigh primary care physician continuity before and during the transition to maintenance dialysis was not associated with a lower risk of mortality or all-cause hospitalization.

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