Objective: To compare early and later adopters of the accountable care organization (ACO) model, using the taxonomy of larger, integrated system; smaller, physician-led; and hybrid ACOs.
Data Sources: The National Survey of ACOs, Waves 1 and 2.
Study Design: Cluster analysis using the two-step clustering approach, validated using discriminant analysis. Wave 2 data analyzed separately to assess differences from Wave 1 and then data pooled across waves.
Findings: Compared to early ACOs, later adopter ACOs included a greater breadth of provider group types and a greater proportion self-reported as integrated delivery systems. When data from the two time periods were combined, a three-cluster solution similar to the original cluster solution emerged. Of the 251 ACOs, 31.1 percent were larger, integrated system ACOs; 45.0 percent were smaller physician-led ACOs; and 23.9 percent were hybrid ACOs-compared to 40.1 percent, 34.0 percent, and 25.9 percent from Wave 1 clusters, respectively.
Conclusions: While there are some differences between ACOs formed prior to August 2012 and those formed in the following year, the three-cluster taxonomy appears to best describe the types of ACOs in existence as of July 2013. The updated taxonomy can be used by researchers, policy makers, and health care organizations to support evaluation and continued development of ACOs.
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http://dx.doi.org/10.1111/1475-6773.12473 | DOI Listing |
Health Aff (Millwood)
January 2025
Michael E. Chernew, Harvard University.
A core problem with the current risk-adjustment system in Medicare Advantage and accountable care organization (ACO) programs-the Hierarchical Condition Categories (HCC) model-is that the inputs (coded diagnoses) can be influenced for gain by risk-bearing plans or providers. Using existing survey data on health status (which provide less manipulable inputs), we found that the use of a hybrid risk score drawing from survey data and a scaled-back set of HCCs would, in addition to mitigating coding incentives, modestly lessen risk-selection incentives, strengthen payment incentives to deliver efficient care, allocate payment across ACOs more efficiently according to markers of population health that are not as affected by practice patterns or coding efforts, and redistribute payment in a manner that supports equity goals. Although sampling error and survey nonresponse present challenges, analyses suggest that these should not be prohibitive.
View Article and Find Full Text PDFAm J Manag Care
December 2024
Institute for Accountable Care, 2001 L St NW, Ste 500, Washington, DC 20036. Email:
Objectives: To describe the prevalence and characteristics of preferred skilled nursing facility (SNF) networks established by Medicare accountable care organizations (ACOs).
Study Design: Cross-sectional analysis of a 2019 Medicare ACO survey.
Methods: We analyzed surveys from 138 Medicare ACOs to assess preferred SNF network prevalence, characteristics, and challenges.
BMC Health Serv Res
December 2024
Larner College of Medicine, University of Vermont, Burlington, VT, USA.
Background: Most approaches to healthcare reform envision an enhanced role for primary care providers, supported by innovative payment methodology and improved resources. However, there are currently no instruments to measure providers' ability and willingness to work with existing tools provided by payers, such as Accountable Care Organizations (ACO). In this study, we develop and psychometrically test a new instrument to measure provider engagement with ACOs.
View Article and Find Full Text PDFJ Public Health Manag Pract
December 2024
Author's Affiliation: Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
Potential changes in health care quality resulting from variation in pandemic severity since 2020 have received less attention. This study aims to assess the relationship between the pandemic and health care quality in Medicare Shared Savings Program (MSSP) accountable care organizations and identify possible heterogeneity in the relationship. The year-by-year difference-in-difference event study of MSSPs between 2016 and 2022 (N = 3390) indicated that 1 standard deviation increase in standardized cumulative COVID-19 incidence in 2020 was associated with a decrease in total quality score of 0.
View Article and Find Full Text PDFAm J Manag Care
December 2024
University of Minnesota, 729 MMC, Minneapolis, MN 55419. Email:
Objectives: To explain key challenges to evaluating Center for Medicare and Medicaid Innovation (CMMI) accountable care organization (ACO) models and ways to address those challenges.
Study Design: We enumerate the challenges, beginning with the conception of the alternative payment model and extending through the decision to scale up the model should the initial evaluation suggest that the model is successful. The challenges include churn at the provider and ACO levels, beneficiary leakage and spillover, participation in prior payment models, and determinants of shared savings and penalties.
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