Association of ACO Shared Savings Success and Serious Illness Spending.
Journal
Journal of healthcare management / American College of Healthcare Executives
ISSN: 1096-9012
Titre abrégé: J Healthc Manag
Pays: United States
ID NLM: 9803529
Informations de publication
Date de publication:
Historique:
entrez:
7
5
2021
pubmed:
8
5
2021
medline:
26
11
2021
Statut:
ppublish
Résumé
Accountable care organizations (ACOs) need confidence in their return on investment to implement changes in care delivery that prioritize seriously ill and high-cost Medicare beneficiaries. The objective of this study was to characterize spending on seriously ill beneficiaries in ACOs with Medicare Shared Savings Program (MSSP) contracts and the association of spending with ACO shared savings. The population included Medicare fee-for-service beneficiaries identified with serious illness (N = 2,109,573) using the Medicare Master Beneficiary Summary File for 100% of ACO-attributed beneficiaries linked to MSSP beneficiary files (2014-2016). Lower spending for seriously ill Medicare beneficiaries and risk-bearing contracts in ACOs were associated with achieving ACO shared savings in the MSSP. For most ACOs, the seriously ill contribute approximately half of the spending and constitute 8%-13% of the attributed population. Patient and geographic (county) factors explained $2,329 of the observed difference in per beneficiary per year spending on seriously ill beneficiaries between high- and low-spending ACOs. The remaining $12,536 may indicate variation as a result of potentially modifiable factors. Consequently, if 10% of attributed beneficiaries were seriously ill, an ACO that moved from the worst to the best quartile of per capita serious illness spending could realize a reduction of $1,200 per beneficiary per year for the ACO population overall. Though the prevalence and case mix of seriously ill populations vary across ACOs, this association suggests that care provided for seriously ill patients is an important consideration for ACOs to achieve MSSP shared savings.
Identifiants
pubmed: 33960968
doi: 10.1097/JHM-D-20-00155
pii: 00115514-202106000-00008
doi:
Types de publication
Journal Article
Langues
eng
Pagination
227-240Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 Foundation of the American College of Healthcare Executives.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Aldridge M. D., Bradley E. H. (2017). Epidemiology and patterns of care at the end of life: Rising complexity, shifts in care patterns and sites of death. Health Affairs (Millwood), 36(7), 1175–1183. https://doi.org/10.1377/hlthaff.2017.0182
doi: 10.1377/hlthaff.2017.0182
Barber J., Thompson S. (2004). Multiple regression of cost data: Use of generalised linear models. Journal of Health Services Research and Policy, 9(4), 197–204. https://doi.org/10.1258/1355819042250249
doi: 10.1258/1355819042250249
Barr L., Loengard A., Hastings L., Gronniger T. (2018, May 11). Payment reform in transition—scaling ACOs for success. Health Affairs (Millwood). https://www.healthaffairs.org/do/10.1377/hblog20180507.812014/full/
doi: 10.1377/hblog20180507.812014/full/
Bleser W. K., Saunders R. S., Muhlestein D. B., McClellan M. (2019). Why do accountable care organizations leave the Medicare shared savings program? Health Affairs (Millwood), 38(5), 794–803. https://doi.org/10.1377/hlthaff.2018.05097
doi: 10.1377/hlthaff.2018.05097
Bleser W. K., Saunders R. S., Winfield L., Japinga M., Smith N., Kaufman B. G., Crook H. L., Muhlestein D. B., McClellan M. (2019). ACO serious illness care: Survey and case studies depict current challenges and future opportunities. Health Affairs (Millwood), 38(6), 1011–1020. https://doi.org/10.1377/hlthaff.2019.00013
doi: 10.1377/hlthaff.2019.00013
Centers for Medicare & Medicaid Services. (n.d.). Chronic conditions data warehouse condition algorithms. https://www.ccwdata.org/web/guest/condition-categories
Colla C. H., Lewis V. A., Stachowski C., Usadi B., Gottlieb D. J., Bynum J. P.W. (2019, April 18). Changes in use of postacute care associated with accountable care organizations in hip fracture, stroke, and pneumonia hospitalized cohorts. Medical Care, https://doi.org/10.1097/mlr.0000000000001121
doi: 10.1097/mlr.0000000000001121
Colla C. H., Lewis V. A., Tierney E., Muhlestein D. B. (2016). Hospitals participating in acos tend to be large and urban, allowing access to capital and data. Health Affairs (Millwood), 35(3), 431–439. https://doi.org/10.1377/hlthaff.2015.0919
doi: 10.1377/hlthaff.2015.0919
Colla C., Yang W., Mainor A. J., Meara E., Ouayogode M. H., Lewis V. A., Shortell S., Fisher E. (2020, October 26). Organizational integration, practice capabilities, and outcomes in clinically complex medicare beneficiaries. Health Services Research, 55(Suppl 3), 1085–1097. https://doi.org/10.1111/1475-6773.13580
doi: 10.1111/1475-6773.13580
Comfort L. N., Shortell S. M., Rodriguez H. P., Colla C. H. (2018). Medicare accountable care organizations of diverse structures achieve comparable quality and cost performance. Health Services Research, 53(4), 2303–2323. https://doi.org/10.1111/1475-6773.12829
doi: 10.1111/1475-6773.12829
Fraze T. K., Beidler L. B., Briggs A. D.M., Colla C. H. (2020). Translating evidence into practice: ACOs’ use of care plans for patients with complex health needs. Journal of General Internal Medicine, 36(1), 147–153. https://doi.org/10.1007/s11606-020-06122-4
doi: 10.1007/s11606-020-06122-4
Gupta R., Roh L., Lee C., Reuben D., Naeim A., Wilson J., Skootsky S. A. (2019, April 9). The population health value framework: Creating value by reducing costs of care for patient subpopulations with chronic conditions. Journal of the Association of American Medical Colleges, 36(1), 147–153. https://doi.org/10.1097/acm.0000000000002739
doi: 10.1097/acm.0000000000002739
Institute of Medicine (2015). Dying in America: Improving quality and honoring individual preferences near the end of life. National Academies Press.
Kaufman B. G., Spivack B. S., Stearns S. C., Song P. H., O’Brien E. C. (2017, December 1). Impact of accountable care organizations on utilization, care, and outcomes: A systematic review. Medical Care Research Review, 36(1), 147–153. https://doi.org/10.1177/1077558717745916
doi: 10.1177/1077558717745916
Kelley A. S. (2013). Epidemiology of care for patients with serious illness. Journal of Palliatiave Medicine, 16(7), 730–733. https://doi.org/10.1089/jpm.2013.9498
doi: 10.1089/jpm.2013.9498
Kelley A. S. (2014). Defining “serious illness”. Journal of Palliatiave Medicine, 17(9), 985. https://doi.org/10.1089/jpm.2014.0164.
doi: 10.1089/jpm.2014.0164
Kelley A. S., Covinsky K. E., Gorges R. J., McKendrick K., Bollens-Lund E., Morrison R. S., Ritchie C. S. (2017). Identifying older adults with serious illness: A critical step toward improving the value of health care. Health Services Research, 52(1), 113–131. https://doi.org/10.1111/1475-6773.12479
doi: 10.1111/1475-6773.12479
Kyle M. A., McWilliams J. M., Landrum M. B., Landon B. E., Trompke P., Nyweide D. J., Chernew M. E. (2020). Spending variation among ACOs in the Medicare Shared Savings Program. American Journal of Managed Care, 26(4), 170–175. https://doi.org/10.37765/ajmc.2020.42834
doi: 10.37765/ajmc.2020.42834
Larson B. K., Van Citters A. D., Kreindler S. A., Carluzzo K. L., Gbemudu J. N., Wu F. M., Nelson E. C., Shortell S. M., Fisher E. S. (2012). Insights from transformations under way at four Brookings-Dartmouth accountable care organization pilot sites. Health Affairs (Millwood), 31(11), 2395–2406. https://doi.org/10.1377/hlthaff.2011.1219
doi: 10.1377/hlthaff.2011.1219
Manning W., Basu A., Mullahy J. (2002). Modeling costs with generalized Gamma Regression. [National Bureau of Economic Research Technical Working Paper No 293], https://www.nber.org/papers/t0293
Markovitz A. A., Hollingsworth J. M., Ayanian J. Z., Norton E. C., Moloci N. M., Yan P. L., Ryan A. M. (2019). Risk adjustment in Medicare ACO program deters coding increases but may lead ACOs to drop high-risk beneficiaries. Health Affairs(Millwood), 38(2.), 253–261. https://doi.org/10.1377/hlthaff.2018.05407
doi: 10.1377/hlthaff.2018.05407
McDermott K., Elixhauser A., Sun R. (2017, June 27). Patient trends in hospital inpatient stays in the United States, 2005-2014 [HCUP Statistical Brief No 225]. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb225-Inpatient-US-Stays-Trends.jsp
McWilliams J. M., Chernew M. E., Landon B. E. (2017). Medicare ACO program savings not tied to preventable hospitalizations or concentrated among high-risk patients. Health Affairs (Millwood), 36(12), 2085–2093. https://doi.org/10.1377/hlthaff.2017.0814
doi: 10.1377/hlthaff.2017.0814
McWilliams J. M., Hatfield L. A., Landon B. E., Chernew M. E. (2020). Savings or selection? Initial spending reductions in the Medicare Shared Savings Program and considerations for reform. Milbank Quarterly, 98(3), 847–907. https://doi.org/10.1111/1468-0009.12468
doi: 10.1111/1468-0009.12468
McWilliams J. M., Hatfield L. A., Landon B. E., Hamed P., Chernew M. E. (2018). Medicare Spending after 3 years of the Medicare Shared Savings Program. New England Journal of Medicine, 379(12), 1139–1149. https://doi.org/10.1056/NEJMsa1803388
doi: 10.1056/NEJMsa1803388
Meier D. E., Back A. L., Berman A., Block S. D., Corrigan J. M., Morrison R. S. (2017). A national strategy for palliative care. Health Affairs (Millwood), 36(7), 1265–1273. https://doi.org/10.1377/hlthaff.2017.0164
doi: 10.1377/hlthaff.2017.0164
Moran J. L., Solomon P. J. (2014). Fixed effects modelling for provider mortality outcomes: Analysis of the Australia and New Zealand Intensive Care Society (ANZICS) Adult Patient Data-base. PLoS One, 9(7), e102297. https://doi.org/10.1371/journal.pone.0102297
doi: 10.1371/journal.pone.0102297
Muhlestein D., McClellan M. (2016, April 21). Accountable care organizations in 2016: Private and public-sector growth and dispersion. Health Affairs (Millwood). http://healthaffairs.org/blog/2016/04/21/ accountable-care-organizations-in-2016-private- and-public-sector-growth-and-dispersion/
Muhlestein D., Saunders R. S., Richards R., McClellan M. (2018). Recent progress in the value journey: growth of ACOs and value-based payment models in 2018. Health Affairs (Millwood). https://www.healthaffairs.org/do/10.1377/hblog20180810.481968/full/
doi: 10.1377/hblog20180810.481968/full/
Mustillo S., Landerman L. R., Land K. C. (2012). Modeling longitudinal count data: Testing for group differences in growth trajectories using average marginal effects. Sociological Methods & Research, 41(3), 467–487. https://doi.org/10.1177_0049124112452397
Nattinger M. C., Mueller K., Ullrich F., Zhu X. (2016). Financial performance of rural Medicare ACOs. Journal of Rural Health, 34(1), 98–102. https://doi.org/10.1111/jrh.12205
doi: 10.1111/jrh.12205
Ouayogodé M. H., Colla C. H., Lewis V. A. (2017). Determinants of success in shared savings programs: An analysis of ACO and market characteristics. Healthcare, 5(1–2), 53–61. https://doi.org/10.1016/j.hjdsi.2016.08.002
doi: 10.1016/j.hjdsi.2016.08.002
Roiland R., Bleser W., Muhlestein D., Saunders R. (2020, January 7). How are ACOs prioritizing palliative care and other serious illness strategies? Duke-Margolis Center for Health Policy. https://healthpolicy.duke.edu/publications/ how-are-acos-prioritizing-palliative-care-and- other-serious-illness-strategies.
Ruiz S., Snyder L. P., Giuriceo K., Lynn J., Ewald E., Branand B., Parashuram S., Loganathan S., Bysshe T. (2018). Innovative models for high-risk patients use care coordination and palliative supports to reduce end-of-life utilization and spending. Innovation in Aging, 1(2.). https://doi.org/10.1093/geroni/igx021
doi: 10.1093/geroni/igx021
Ruiz S., Snyder L. P., Rotondo C., Cross-Barnet C., Colligan E. M., Giuriceo K. (2017). Innovative home visit models associated with reductions in costs, hospitalizations, and emergency department use. Health Affairs (Millwood), 36(3), 425–432. https://doi.org/10.1377/hlthaff.2016.1305
doi: 10.1377/hlthaff.2016.1305
Schulz J., DeCamp M., Berkowitz A. S.A. (2018). Spending patterns among Medicare ACOs that have reduced costs. Journal of Healthcare Management, 63(6), 374–381. https://doi.org/10.1097/jhm-d-17-00178
doi: 10.1097/jhm-d-17-00178
Szanton S. L., Alfonso Y. N., Leff B., Guralnik J., Wolff J. L., Stockwell I., Gitlin L. N., Bishai D. (2018). Medicaid cost savings of a preventive home visit program for disabled older adults. Journal of the American Geriatrics Society, 66(3), 614–620. https://doi.org/10.1111/jgs.15143
doi: 10.1111/jgs.15143
Trombley M. J., Fout B., Brodsky S., McWilliams J. M., Nyweide D. J., Morefield B. (2019). Early effects of an accountable care organization model for underserved areas. New England Journal of Medicine, 381:543–551. https://doi.org/10.1056/NEJMsa1816660
doi: 10.1056/NEJMsa1816660
Yosick L., Crook R. E., Gatto M., Maxwell T. L., Duncan I., Ahmed T., Mackenzie A. (2019). Effects of a population health community-based palliative care program on cost and utilization. Journal of Palliative Medicine, 22(9), 1075–1081. https://doi.org/10.1089/jpm.2018.0489
doi: 10.1089/jpm.2018.0489
Zhu X., Mueller K., Huang H., Ullrich F., Vaughn T., MacKinney A. C. (2019). Organizational attributes associated with Medicare ACO quality performance. Journal of Rural Health, 35(1), 68–77. https://doi.org/10.1111/jrh.12304
doi: 10.1111/jrh.12304