Association between medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries

JAMA Internal Medicine

Volumn 176, Issue 8, 2016, Pages 1167-1175

  Colla, Carrie H ^a,b   Lewis, Valerie A ^a   Kao, Lee Sien ^a   O'Malley, A James ^a   Chang, Chiang Hua ^a   Fisher, Elliott S ^a  

^a DARTMOUTH INSTITUTE FOR HEALTH POLICY AND CLINICAL PRACTICE   (United States)

^b NORRIS COTTON CANCER CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACCOUNTABLE CARE ORGANIZATION; AGED; AMBULATORY CARE; ARTICLE; CLINICALLY VULNERABLE BENEFICIARY; COHORT ANALYSIS; CONTRACT; CONTROLLED STUDY; COST CONTROL; EMERGENCY CARE; EMERGENCY WARD; FEMALE; FINANCIAL MANAGEMENT; HEALTH CARE MANAGEMENT; HOSPICE CARE; HOSPITAL ADMISSION; HOSPITAL READMISSION; HOSPITAL UTILIZATION; HOSPITALIZATION; HUMAN; LONG TERM CARE; MAJOR CLINICAL STUDY; MALE; MEDICAL DEVICE; MEDICARE; PATIENT CODING; PHYSICIAN; PRIORITY JOURNAL; VERY ELDERLY; VULNERABLE POPULATION; ECONOMICS; HEALTH CARE COST; HEALTH CARE POLICY; MEDICAL FEE; MIDDLE AGED; STATISTICS AND NUMERICAL DATA; UNITED STATES;

ACCOUNTABLE CARE ORGANIZATIONS; AGED; COHORT STUDIES; FEE-FOR-SERVICE PLANS; FEMALE; HEALTH EXPENDITURES; HUMANS; MALE; MEDICARE; MIDDLE AGED; PATIENT PROTECTION AND AFFORDABLE CARE ACT; UNITED STATES; VULNERABLE POPULATIONS;

EID: 84980416343     PISSN: 21686106     EISSN: None     Source Type: Journal    
DOI: 10.1001/jamainternmed.2016.2827     Document Type: Article

References (37)

1. Muhlestein D, Gardner P, Caughey W, deLisle K. Projected Growth of Accountable Care Organizations. Leavitt Partners. http://leavittpartners.com/2015/12/projected-growth-of-accountable-care-organizations-2/. Published online December 23, 2015. Accessed May 19, 2016.
2. Colla CH, Wennberg DE, Meara E, et al. Spending differences associated with the Medicare Physician Group Practice Demonstration. JAMA. 2012;308 (10):1015-1023.
3. McWilliams JM, Hatfield LA, Chernew ME, Landon BE, Schwartz AL. Early Performance of Accountable Care Organizations in Medicare. [published online April 13, 2016]. N Engl J Med. 2016. doi:10.1056/NEJMsa1600142.
4. Nyweide DJ, Lee W, Cuerdon TT, et al. Association of Pioneer Accountable Care Organizations vs traditional Medicare fee for service with spending, utilization, and patient experience. JAMA. 2015;313(21):2152-2161.
5. McWilliams JM, Chernew ME, Landon BE, Schwartz AL. Performance differences in year 1 of pioneer accountable care organizations. N Engl J Med. 2015;372(20):1927-1936.
6. Zusman EE, Carr SJ, Robinson J, et al. Moving toward implementation: the potential for accountable care organizations and private-public partnerships to advance active neighborhood design. Prev Med. 2014;69(suppl 1):S98-S101.
7. Genesis Health Care. New hospitals and health care providers join successful, cutting-edge federal initiative that cuts costs and puts patients at the center of their care. http://www.prnewswire.com/news-releases/new-hospitals-and-health-care-providers-join-successful-cutting-edge-federal-initiative-that-cuts-costs-and-puts-patients-at-the-center-of-their-care-300215344.html. Accessed May 19, 2016.
8. Centers for Medicare and Medicaid Services. Comprehensive ESRD Care Model. https://innovation.cms.gov/initiatives/comprehensive-esrd-care/. Accessed May 19, 2016.
9. Kline RM, Bazell C, Smith E, Schumacher H, Rajkumar R, Conway PH. Centers for medicare and medicaid services: using an episode-based payment model to improve oncology care. J Oncol Pract. 2015;11(2):114-116.
10. Lewis VA, Colla CH, Schoenherr KE, Shortell SM, Fisher ES. Innovation in the safety net: integrating community health centers through accountable care. J Gen Intern Med. 2014;29(11): 1484-1490.
11. Bailit M, Tobey R, Maxwell J, Bateman C. The ACO Conundrum: Safety-Net Hospitals in the Era of Accountable Care. http://www.bailit-health.com/articles/2015-0504-bhp-jsi-rwjf-aco-conundrum.pdf. Accessed May 19, 2016.
12. Boult C, Reider L, Leff B, et al. The effect of guided care teams on the use of health services: results from a cluster-randomized controlled trial. Arch Intern Med. 2011;171(5):460-466.
13. Counsell SR, Callahan CM, Clark DO, et al. Geriatric care management for low-income seniors: a randomized controlled trial. JAMA. 2007;298(22): 2623-2633.
14. Asch SM, Sloss EM, Hogan C, Brook RH, Kravitz RL. Measuring underuse of necessary care among elderly Medicare beneficiaries using inpatient and outpatient claims. JAMA. 2000;284 (18):2325-2333.
15. Hempstead K, Delia D, Cantor JC, Nguyen T, Brenner J. The fragmentation of hospital use among a cohort of high utilizers: implications for emerging care coordination strategies for patients with multiple chronic conditions. Med Care. 2014;52(3) (suppl 3):S67-S74.
16. Centers for Medicare and Medicaid Services. Chronic Conditions Among Medicare Beneficiaries Chartbook. 2012 ed. Baltimore, MD. 2012.
17. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716-724.
18. United States. Congressional Budget Office. High-cost Medicare beneficiaries. Washington, D.C.: Congressional Budget Office; 2005.
19. Song Z, Rose S, Safran DG, Landon BE, Day MP, Chernew ME. Changes in health care spending and quality 4 years into global payment. N Engl J Med. 2014;371(18):1704-1714.
20. Centers for Medicare and Medicaid Services. Medicare Shared Savings Program Shared Savings and Losses and Assignment Methodology Specifications. 2014. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/Shared-Savings-Losses-Assignment-Spec-v2.pdf. Accessed May 19, 2016.
21. Pope GC, Kautter J, Ellis RP, et al. Risk adjustment of Medicare capitation payments using the CMS-HCC model. Health Care Financ Rev. 2004;25(4):119-141.
22. Feng Z, Wright B, Mor V. Sharp rise in Medicare enrollees being held in hospitals for observation raises concerns about causes and consequences. Health Aff (Millwood). 2012;31(6):1251-1259.
23. Agency for Healthcare Research and Quality. National Quality Measures Clearinghouse. Ambulatory care sensitive conditions: age-standardized acute care hospitalization rate for conditions where appropriate ambulatory care prevents or reduces the need for admission to the hospital, per 100,000 population younger than age 75 years. 2013. https://www.qualitymeasures.ahrq.gov/content.aspx?id=48964. Accessed May 19, 2016.
24. Eicheldinger C, Bonito A. More accurate racial and ethnic codes for Medicare administrative data. Health Care Financ Rev. 2008;29(3):27-42.
25. Schore JL, Brown RS, Cheh VA. Case management for high-cost Medicare beneficiaries. Health Care Financ Rev. 1999;20(4):87-101.
26. Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA. 2009; 301(6):603-618.
27. McWilliams JM, Chernew ME, Zaslavsky AM, Hamed P, Landon BE. Delivery system integration and health care spending and quality for Medicare beneficiaries. JAMA Intern Med. 2013;173(15): 1447-1456.
28. Lewis VA, Colla CH, Carluzzo KL, Kler SE, Fisher ES. Accountable Care Organizations in the United States: market and demographic factors associated with formation. Health Serv Res. 2013; 48(6 Pt 1):1840-1858.
29. Colla CH, Lewis VA, Bergquist SL, Shortell SM. Accountability across the Continuum: the participation of postacute care providers in accountable care organizations [published online January 22, 2016]. Health Serv Res. 2016. doi:10.1111/1475-6773.12442.
30. Colla CH, Lewis VA, Shortell SM, Fisher ES. First national survey of ACOs finds that physicians are playing strong leadership and ownership roles. Health Aff (Millwood). 2014;33(6):964-971.
31. Adams AJ, Clark DR, DeLander GE, et al. Report of the AACP task force on patient-centered medical homes and accountable care organizations. Am J Pharm Educ. 2013;77(7):142.
32. Hong CS, Siegel AL, Ferris TG. Caring for high-need, high-cost patients: what makes for a successful care management program? Issue Brief (Commonw Fund). 2014;19:1-19.
33. Klein S. In focus: Building Accountable Care Organizations That Improve Quality And Lower Costs-A View From The Field. 2010. http://www.commonwealthfund.org/publications/newsletters/quality-matters/2010/june-july-2010/in-focus. Accessed May 19, 2016.
34. United Health Center for Health Reform & Modernization. Advancing Primary Care Delivery: Practical, Proven, and Scalable Approaches. 2014. http://www.unitedhealthgroup.com/~/media/UHG/PDF/2014/UNH-Primary-Care-Report-Advancing-Primary-Care-Delivery.ashx. Accessed May 19, 2016.
35. Welch HG, Sharp SM, Gottlieb DJ, Skinner JS, Wennberg JE. Geographic variation in diagnosis frequency and risk of death among Medicare beneficiaries. JAMA. 2011;305(11):1113-1118.
36. Song Y, Skinner J, Bynum J, Sutherland J, Wennberg JE, Fisher ES. Regional variations in diagnostic practices. N Engl J Med. 2010;363(1): 45-53.
37. Centers for Medicare and Medicaid Services. Medicare ACOs Continue to Improve Quality of Care, Generate Shared Savings. 2015. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-08-25.html. Accessed May 19, 2016.