Patient Experiences of Integrated Care in Medicare Accountable Care Organizations and Medicare Advantage Versus Traditional Fee-for-Service.
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
pubmed:
5
12
2020
medline:
7
5
2021
entrez:
4
12
2020
Statut:
ppublish
Résumé
Health insurance design can influence the extent to which clinical care is well-coordinated. Through alternative payment models, Medicare Advantage (MA) and Accountable Care Organizations (ACOs) have the potential to improve integration relative to traditional fee-for-service (FFS) Medicare. To characterize patient experiences of integrated care within Medicare and identify whether MA or ACO beneficiaries perceive greater integration than FFS beneficiaries. Retrospective cross-sectional analysis of the 2015 Medicare Current Beneficiary Survey. Nationally representative sample of 11,978 Medicare beneficiaries. Main outcomes included 8 previously derived domains of patient-perceived integrated care (PPIC), measured on a scale of 1-4. The final sample was 55% female with a mean (SD) age of 71.1 (11.3). In unadjusted analyses, we observed considerable variation across PPIC domains in the full sample, but little variation across subsamples defined by coverage type within a given PPIC domain. In linear models adjusting for a rich set of patient characteristics, we observe no significant benefits of ACOs nor MA relative to FFS, a finding which is robust to alternative specifications and adjustment for multiple comparisons. We similarly observed no benefits in subgroup analyses restricted to states with relatively high market penetration of ACOs or MA. Despite characteristics of ACOs and MA that theoretically promote integrated care, we find that PPIC is largely similar across coverage types in Medicare.
Sections du résumé
BACKGROUND
Health insurance design can influence the extent to which clinical care is well-coordinated. Through alternative payment models, Medicare Advantage (MA) and Accountable Care Organizations (ACOs) have the potential to improve integration relative to traditional fee-for-service (FFS) Medicare.
OBJECTIVE
To characterize patient experiences of integrated care within Medicare and identify whether MA or ACO beneficiaries perceive greater integration than FFS beneficiaries.
DESIGN
Retrospective cross-sectional analysis of the 2015 Medicare Current Beneficiary Survey.
SUBJECTS
Nationally representative sample of 11,978 Medicare beneficiaries.
MEASURES
Main outcomes included 8 previously derived domains of patient-perceived integrated care (PPIC), measured on a scale of 1-4.
RESULTS
The final sample was 55% female with a mean (SD) age of 71.1 (11.3). In unadjusted analyses, we observed considerable variation across PPIC domains in the full sample, but little variation across subsamples defined by coverage type within a given PPIC domain. In linear models adjusting for a rich set of patient characteristics, we observe no significant benefits of ACOs nor MA relative to FFS, a finding which is robust to alternative specifications and adjustment for multiple comparisons. We similarly observed no benefits in subgroup analyses restricted to states with relatively high market penetration of ACOs or MA.
CONCLUSIONS
Despite characteristics of ACOs and MA that theoretically promote integrated care, we find that PPIC is largely similar across coverage types in Medicare.
Identifiants
pubmed: 33273291
pii: 00005650-202103000-00002
doi: 10.1097/MLR.0000000000001463
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
195-201Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Mcguire TGCulyer AJ, Newhouse JP. Physician agency. Handbook of Health Economics (Vol 1). Amsterdam, NE: Elsevier; 2000:461–536.
Davis K. Paying for care episodes and care coordination. N Engl J Med. 2007;356:1166–1168.
Newhouse JP. Reimbursing health plans and health providers: efficiency in production versus selection. J Econ Lit. 1996;34:1236–1263.
Singer SJ, Burgers J, Friedberg M, et al. Defining and measuring integrated patient care: promoting the next frontier in health care delivery. Med Care Res Rev. 2011;68:112–127.
Averill RF, Goldfield NI, Vertrees JC, et al. Achieving cost control, care coordination, and quality improvement through incremental payment system reform. J Ambul Care Manage. 2010;33:2–23.
Joynt KE, Figueroa JF, Beaulieu N, et al. Segmenting high-cost Medicare patients into potentially actionable cohorts. Healthcare. 2017;5:62–67.
Centers for Medicare and Medicaid Services. Chronic conditions among Medicare beneficiaries. Chartbook, 2012 ed. 2012. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/Downloads/2012Chartbook.pdf . Accessed October 8, 2018.
Gerteis J, Izrael D, Deitz D, et al. Multiple chronic conditions chartbook. AHRQ Publ No, Q14-0038. 2014. Available at: https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdf . Accessed October 8, 2018.
Nolte E, McKee MNolte E, McKee M. Integration and chronic care: a review. Caring for People With Chronic Conditions: A Health System Perspective (ISBN 978 92 890 4294 9). Berkshire, UK: McGraw-Hill Education; 2008:64–86.
Kaiser Family Foundation. Medicare advantage. 2017. Available at: https://www.kff.org/medicare/fact-sheet/medicare-advantage/ . Accessed October 8, 2018.
Newhouse JP, Price M, Michael Mcwilliams J, et al. How much favorable selection is left in medicare advantage? Am J Heal Econ. 2015;1:1–26.
Werner RM, Kanter G, Polsky D. Association of physician group participation in accountable care organizations with patient social and clinical characteristics. JAMA Netw Open. 2019;2:e187220.
Niles J, Litton T, Mechanic R. An initial assessment of initiatives to improve care for high-need, high-cost individuals in accountable care organizations. 2019. Available at: https://www.healthaffairs.org/do/10.1377/hblog20190411.143015/full/ . Accessed February 1, 2019.
doi: 10.1377/hblog20190411.143015/full/
Brennan N, Shepard M. Comparing quality of care in the medicare program. Am J Manag Care. 2010;16:841–848.
Landon BE, Zaslavsky AM, Saunders RC, et al. Analysis of medicare advantage HMOs compared with traditional medicare shows lower use of many services during 2003-09. Health Aff. 2012;31:2609–2617.
Epstein AM, Jha AK, Orav EJ, et al. Analysis of early accountable care organizations defines patient, structural, cost, and quality-of-care characteristics. Health Aff. 2014;33:95–102.
Shimada SL, Zaslavsky AM, Zaborski LB, et al. Market and beneficiary characteristics associated with enrollment in Medicare managed care plans and fee-for-service. Med Care. 2009;47:517–523.
Jacobson G, Damico A, Neuman T. A dozen facts about Medicare advantage. 2018. Available at: https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage/ . Accessed January 22, 2019.
Centers for Medicare and Medicaid Services. Medicare shared savings program fast facts. 2018. Available at: https://www.cms.gov/medicare/medicare-fee-for-service-payment/sharedsavingsprogram/downloads/ssp-2018-fast-facts.pdf . Accessed October 8, 2018.
Singer SJ, Friedberg MW, Kiang MV, et al. Development and preliminary validation of the patient perceptions of integrated care survey. Med Care Res Rev. 2012;70:143–164.
Kerrissey MJ, Clark JR, Friedberg MW, et al. Medical group structural integration may not ensure that care is integrated, from the patient’s perspective. Health Aff. 2017;36:885–892.
Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the life orientation test. J Pers Soc Psychol. 1994;67:1063–1078.
Parker J, Regan J, Petroski J. Beneficiary activation in the Medicare population. Medicare Medicaid Res Rev. 2014;4:E1–E14.
Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff. 2013;32:207–214.
Hibbard JH, Greene J, Overton V. Patients with lower activation associated with higher costs; delivery systems should know their patients’ ‘scores’. Health Aff. 2013;32:216–222.
Benjamini Y, Yekutieli D. The control of the false discovery rate in multiple testing under dependency. Ann Stat. 2001;29:1165–1188.
Health Care Payment Learning & Action Network. Measuring progress: adoption of alternative payment models in commercial, Medicaid, Medicare advantage, and fee-for-service Medicare programs; 2016.
McWilliams JM, Landon BE, Chernew ME, et al. Changes in patients’ experiences in Medicare accountable care organizations. N Engl J Med. 2014;371:1715–1724.
Nyweide DJ, Lee W, Cuerdon TT, et al. Association of pioneer accountable care organizations vs traditional medicare fee for service with spending, utilization, and patient experience. JAMA. 2015;313:2152–2161.
Diana ML, Zhang Y, Yeager VA, et al. The impact of accountable care organization participation on hospital patient experience. Health Care Manage Rev. 2019;44:148–158.
Kaiser Family Foundation. 10 essential facts about Medicare and prescription drug spending; 2019. Available at: https://www.kff.org/infographic/10-essential-facts-about-medicare-and-prescription-drug-spending/ . Accessed March 5, 2019.
Kaiser Family Foundation. Medicare service use: home health services. 2014. Available at: https://www.kff.org/medicare/state-indicator/medicare-service-use-home-health-services/ . Accessed March 5, 2019.
Verhaegh KJ, MacNeil-Vroomen JL, Eslami S, et al. Transitional care interventions prevent hospital readmissions for adults with chronic illnesses. Health Aff. 2014;33:1531–1539.