What value do teaching hospitals provide commercial beneficiaries when in an ACO?

Objectives: The number of commercial beneficiaries cared for by accountable care organizations (ACOs) is growing, but the literature examining their trends is nascent.

Study Design: We examined commercial claims data from 2019 to 2021 to compare beneficiaries attributed to participants in Medicare Shared Savings Program ACOs with and without a major teaching hospital.

Methods: We calculated mortality and spending by setting for each ACO type by year.

Trends in sepsis and pneumonia during COVID-19: lessons from BPCIA.

Objectives: The COVID-19 pandemic affected care delivery nationwide for all patients, influencing cost and utilization for patients both with and without COVID-19. Our first analysis assessed changes in utilization for patients with sepsis without COVID-19 prior to vs during the pandemic. Our second analysis assessed cost and utilization changes during the pandemic for patients with sepsis or pneumonia both with and without COVID-19.

Succeeding in Medicare's newest bundled payment program: Results from teaching hospitals.

Background: In 2018, Medicare implemented a successor to its Bundled Payments for Care Improvement (BPCI) program, BPCI Advanced, with stricter participation rules and new financial incentives to reduce spending.

Methods: Using claims-based episode data from thirteen participants, we compared spending and utilization in the first fifteen months of the new program (October 2018 to December 2019) to hospital- and episode-specific target prices, with a deep dive into clinical correlates for the most commonly-selected clinical episodes, sepsis and congestive heart failure.

Results: Twelve out of thirteen participants in a collaborative of teaching hospitals achieved shared savings for both Medicare and their own institution.

Evaluating the Addition of Clinical and Staging Data to Improve the Pricing Methodology of the Oncology Care Model.

Purpose: The Oncology Care Model (OCM) is the largest value-based care model focusing on oncology, but the current pricing methodology excludes relevant data on the cancer stage and current clinical status, limiting the precision of the risk adjustment.

Methods: This analysis evaluated 15,580 episodes of breast cancer, lung cancer, and multiple myeloma, starting between July 1, 2016, and January 1, 2020, with data from a cohort of OCM practices affiliated with academic medical centers. The authors merged clinical data with claims for OCM episodes defined by the Center for Medicare and Medicaid Innovation to identify potential quality improvement opportunities.

Patient Outcomes in a Medicaid Managed Care Lock-In Program.

Background: Prescription drug abuse is a growing epidemic in the United States, and opioids are among the most commonly abused and misused controlled substances. Managed care organizations can use pharmacy lock-in programs to limit patients' access to opioids by requiring that they receive all scripts from 1 prescriber, potentially reducing inappropriate use.

Objective: To evaluate opioid use patterns among patients in a Medicaid managed care lock-in program limiting opioid coverage to prescriptions written by assigned prescribers.