scholarly journals Pandemic Pause: Systematic Review of Cost Variables for Ambulatory Care Organizations Participating in Accountable Care Organizations

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 198
Author(s):  
Cristian Lieneck ◽  
Eric Weaver ◽  
Thomas Maryon
Keyword(s):  
Systematic Review ◽  
Ambulatory Care ◽  
Financial Incentives ◽  
Accountable Care Organizations ◽  
Care Organization ◽  
Accountable Care ◽  
Quality Reporting ◽  
Reporting Requirements ◽  
Value Based Care ◽  
Ambulatory Health Care

Ambulatory health care provider organizations participating in Accountable Care Organizations (ACOs) organizations assume costs beyond typical practice operations that are directly associated with value-based care initiatives. Identifying these variables that influence such costs are essential to an organization’s financial viability. To enable the U.S. healthcare system to respond to the COVID-19 pandemic CMS issued blanket waivers that permit enhanced flexibility, extension, and other emergency declaration changes to ACO reporting requirements through the unforeseen future. This relaxation and even pausing of reporting requirements encouraged the researchers to conduct a systematic review and identify variables that have influenced costs incurred by ambulatory care organizations participating in ACOs prior to the emergency declaration. The research findings identified ACO-ambulatory care variables (enhanced patient care management, health information technology improvements, and organizational ownership/reimbursement models) that helped to reduce costs to the ambulatory care organization. Additional variables (social determinants of health/environmental conditions, lack of integration/standardization, and misalignment of financial incentives) were also identified in the literature as having influenced costs for ambulatory care organizations while participating in an ACO initiative with CMS. Findings can assist ambulatory care organizations to focus on new and optimized strategies as they begin to prepare for the post-pandemic resumption of ACO quality reporting requirements once the emergency declaration is eventually lifted.

Clinical Response and Cost-Savings Associated With Generic Fluticasone Propionate/Salmeterol Multidose, Dry-Powder Inhaler in Asthma Patients Managed in an Ambulatory Care Practice Setting

2020 ◽  
pp. 089719002096925
Author(s):  
Patrick McCarthy ◽  
Tanya Iliadis ◽  
Kathy Zaiken
Keyword(s):  
Fluticasone Propionate ◽  
Ambulatory Care ◽  
Clinical Response ◽  
Asthma Control ◽  
Dry Powder Inhaler ◽  
Cost Savings ◽  
Care Organization ◽  
Accountable Care ◽  
Brand Name ◽  
Prescription Cost

Background: Fluticasone propionate/salmeterol multidose, dry powder inhaler (MDPI) was the first and only authorized generic inhaled corticosteroid/long-acting beta agonist (ICS/LABA) combination inhaler at the time of this study. This offers the potential for significant prescription cost-savings for both patients and accountable care organizations. The objective of the study was to demonstrate patients’ clinical response to generic fluticasone propionate/salmeterol MDPI when switched from one of its brand name competitors. Methods: The study was approved by the Institutional Review Board at MCPHS University. This was a prospective chart review of a large, multi-center ambulatory care organization in the Greater Boston area. Patients 12 years of age or older who were switched from a brand-name ICS/LABA inhaler to the generic fluticasone/salmeterol MDPI were included in the study. The primary endpoint was worsened asthma control requiring a change in therapy, oral corticosteroid therapy, or hospitalization at or before 12 weeks after the inhaler was switched. Results: In total, 203 patients met inclusion criteria. Of those 203 patients, 35 had a change in therapy due to worsened asthma control (17.2% of patients, 95% CI 12.0% to 22.4%) within 12 weeks. Total projected yearly prescription cost-savings for patients who were switched and remained on the generic inhaler was $581,628. Conclusion: Eighty-three percent of patients maintained appropriate asthma control after switching from a brand ICS/LABA inhaler to the generic fluticasone/salmeterol MDPI for 12 weeks. Switching to the generic inhaler resulted in significant prescription cost-savings for the accountable care organization.

Performance of Accountable Care Organizations: Health Information Technology and Quality–Efficiency Trade-Offs

2021 ◽  
Author(s):  
Chenzhang Bao ◽  
Indranil R. Bardhan
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Financial Incentives ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Cost Of Care ◽  
Accountable Care Organizations ◽  
Accountable Care ◽  
Trade Offs

Under a traditional fee-for-service payment model, healthcare providers typically compromise the quality of care in order to reduce costs. Drawing on data from a national sample of accountable care organizations (ACOs), we study whether financial incentives offered under the Affordable Care Act led to fundamental changes in care delivery. Our research suggests that effective use of health information technology (IT) by ACO providers is critical in balancing competing goals of quality and efficiency. Unlike hospitals that did not participate in value-based care initiatives, ACOs were able to generate better quality outcomes while also improving overall efficiency. Furthermore, ACO providers that used health IT effectively demonstrated better patient health outcomes due to greater information integration with other providers. In other words, ACOs created value by not only reducing the cost of care but also improving patient outcomes simultaneously. Our research provides a roadmap for practitioners to succeed in a value-based healthcare environment and for policy makers to design better incentives to promote interorganizational information sharing across providers. Our findings suggest that healthcare policy needs to incorporate appropriate incentives to foster effective IT use for care coordination between healthcare providers.

scholarly journals The impacts of accountable care organizations on patient experience, health outcomes and costs: a rapid review

2020 ◽  
Vol 25 (2) ◽  
pp. 130-138
Author(s):  
Michael Wilson ◽  
Adrian Guta ◽  
Kerry Waddell ◽  
John Lavis ◽  
Robert Reid ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Patient Experience ◽  
Accountable Care Organization ◽  
Accountable Care Organizations ◽  
Rapid Review ◽  
Care Organization ◽  
Fee For Service ◽  
Accountable Care ◽  
Quadruple Aim ◽  
Service Models

Objectives Accountable care organizations were implemented as a system-level approach to address quality differences and curb increasing healthcare costs in the United States of America, and have garnered the interest of policy makers in other countries to support better management of patients. The objectives of this paper are to: (1) identify the impacts of accountable care organizations on improving the quadruple aim goals of improving patient experience of care, enhancing population health outcomes, reducing the per capita cost of health care and ensuring positive provider experiences and (2) determine how and why such impacts have been achieved through accountable care organizations. Methods We used a rapid review approach, searching Health Systems Evidence (for systematic reviews) and PubMed (for reviews and studies). Results were reviewed for inclusion independently by two researchers. Data were extracted by one reviewer and checked for consistency by another. Results We identified one recent systematic review and 59 primary studies that addressed the first objective ( n = 54), the second objective ( n = 4) or both objectives ( n = 1). The reviewed studies suggest that accountable care organizations reduce costs without reducing quality. Key findings related to objective 1 include: (1) there are positive trends across the quadruple–aim outcomes for accountable care organizations as compared to Medicare fee-for-service or group physician fee-for-service models; (2) accountable care organizations produced modest cost savings, which are largely attributable to savings in outpatient expenses among the most medically complex patients and reductions in the delivery of low-value services; (3) accountable care organization models met the majority of quality measures and perform better than their fee-for-service counterparts and (4) there is relatively little evidence about the impact of accountable care organizations on provider experience. Qualitative studies related to objective 2 highlighted mechanisms that were important for enabling accountable care organizations, including supplemental staff to enhance coordination and accountable care organization-wide electronic health records. Conclusions General trends and increased adoption of models similar to accountable care organizations outside of the USA suggest that these models outperform traditional fee-for-service models across the quadruple aim goals, although with mixed evidence about health outcomes.

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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