Physicians' willingness to change how care is delivered is a key component of the ability of accountable care organizations (ACOs) to transform patient care. Yet physicians participating in Medicare ACOs are only moderately convinced that ACOs are an effective model for delivering cost-effective care.
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| http://dx.doi.org/10.1377/hlthaff.2016.1427 | DOI Listing |
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Background: Prior research has explored the link between health information technology (HIT) and performance of accountable care organizations (ACOs). However, the challenges of HIT use in ACOs for the management of chronic diseases among Medicare beneficiaries remain less examined.
Purpose: Given the high costs of implementing HIT and the occurrence of multiple chronic conditions (MCC) among elderly individuals, it is important to understand the extent to which HIT capabilities enable chronic disease management among the Medicare population.
Use Of Patient Health Survey Data For Risk Adjustment To Limit Distortionary Coding Incentives In Medicare.
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 PDFCharacteristics of accountable care organizations' preferred skilled nursing facility networks.
Am 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.
Association and Variation Between the COVID-19 Pandemic and Health Care Quality in the Medicare Shared Savings Program: Insights From a Seven-Year Natural Experiment.
J 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 PDFSearching for the policy-relevant treatment effect in Medicare's ACO evaluations.
Am 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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