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Do Medicare Accountable Care Organizations Impact Health Care Utilization among Long-Stay Nursing Home Residents?
J Am Med Dir Assoc
March 2025
Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, Providence VA Medical Center, Providence, RI, USA.
Objectives: Nursing home (NH) residents are high-cost, high-need Medicare beneficiaries. Accountable Care Organizations (ACOs) have the potential to improve quality of care and reduce potentially unnecessary health care utilization. This study aimed to assess the impact of Medicare Shared Savings Program (MSSP) ACOs on health care utilization among long-stay NH residents.
View Article and Find Full Text PDFCharacteristics of home-based care provided by accountable care organizations.
Am J Manag Care
May 2022
Brandeis University, 415 South St, MS035, Waltham, MA 02454. Email:
Objectives: To describe the use of home-based services in accountable care organizations (ACOs).
Study Design: Cross-sectional analysis of 2019 ACO survey.
Methods: We analyzed surveys completed by 151 ACOs describing the characteristics of home-based care programs serving high-need, high-cost patients.
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).
View Article and Find Full Text PDFUtilization by Long-Term Nursing Home Residents Under Accountable Care Organizations.
J Am Med Dir Assoc
February 2021
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH.
Objectives: Nursing home care is common and costly. Accountable care organization (ACO) payment models, which have incentives for care that is better coordinated and less reliant on acute settings, have the potential to improve care for this high-cost population. We examined the association between ACO attribution status and utilization and Medicare spending among long-term nursing home residents and hypothesized that attribution of nursing home residents to an ACO will be associated with lower total spending and acute care use.
View Article and Find Full Text PDFPerformance in the Medicare Shared Savings Program After Accounting for Nonrandom Exit: An Instrumental Variable Analysis.
Ann Intern Med
July 2019
University of Michigan School of Public Health, Center for Evaluating Health Reform, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan (A.M.R.).
Background: Accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) are associated with modest savings. However, prior research may overstate this effect if high-cost clinicians exit ACOs.
Objective: To evaluate the effect of the MSSP on spending and quality while accounting for clinicians' nonrandom exit.
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