Payment Reform for Primary Care Within the Accountable Care Organization

JAMA ◽  
2012 ◽  
Vol 308 (6) ◽  
pp. 577 ◽  
Author(s):  
Allan H. Goroll ◽  
Stephen C. Schoenbaum
Keyword(s):  
Primary Care ◽  
Accountable Care Organization ◽  
Care Organization ◽  
Accountable Care ◽  
Payment Reform

impact of a Pharmacy-Led Transitions of Care Program Within a Primary Care-Based Accountable Care Organization

2021 ◽  
Vol 36 (6) ◽  
pp. 311-316
Author(s):  
Tina Joseph ◽  
Genevieve M. Hale ◽  
Cynthia Moreau ◽  
Stephanie L. Kourtakis ◽  
William R. Wolowich
Keyword(s):  
Primary Care ◽  
Primary Outcome ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Program ◽  
Accountable Care Organization ◽  
Transitions Of Care ◽  
Care Organization ◽  
Pharmacy Services ◽  
Accountable Care

OBJECTIVE: To assess the impact of pharmacist-led transitions of care program on 30-day readmission rates in the accountable care organization (ACO) primary care setting. DESIGN: Retrospective cohort study. SETTING: Two primary care provider (PCP) offices with an ACO in South Florida. PATIENTS, PARTICIPANTS: Adult Medicare patients who completed a post-discharge follow-up visit at two primary care offices within an ACO from July to December 2017. INTERVENTIONS: To supplement postdischarge visits with a PCP, the pharmacy services were also provided two days per week with a PCP. The comparator groups were patients who only saw a PCP or those who saw a PCP and pharmacist. MAIN OUTCOME MEASUREMENTS: The primary outcome was hospital readmission or emergency department visit within 30 days. RESULTS: A total of 190 subjects were included. There were 113 patients in the PCP group and 77 patients in the PCP/pharmacist group. There was a reduction in the primary outcome when comparing the PCP-only versus PCP/pharmacist groups (6.2% versus 3.9%; P = 0.74). CONCLUSION: Involving pharmacists in patient transitions of care in the primary care setting may be beneficial as previous studies have demonstrated. Further studies evaluating pharmacy services in emerging health care models are needed in order to most effectively utilize the expertise of the pharmacy team.

scholarly journals Clinic Exploration of Care Processes to Promote Colorectal Cancer Screening in Rural Accountable Care Organization Clinics: A Qualitative Case Study

2019 ◽  
Author(s):  
Sarbinaz Bekmuratova ◽  
Jungyoon Kim ◽  
Hongmei Wang ◽  
Lufei Young ◽  
Daniel Schober ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Health Care Providers ◽  
Rural Areas ◽  
Accountable Care Organization ◽  
Care Process ◽  
Care Organization ◽  
Accountable Care ◽  
Care Providers ◽  
Crc Screening

It is essential to have an effective care process to promote colorectal cancer (CRC) screening particularly in rural areas. Primary care health care providers may have a significant impact on improving CRC screening rates among rural residents through systematic screening processes in their clinics. In this qualitative study, we aimed to explore the whole clinic processes of recommending and referring CRC screening in the rural accountable care organization (ACO) primary care clinics. We collected qualitative data through 21 semi-structured in-depth interviews with healthcare providers in rural primary care ACO clinics in Nebraska. We audio recorded and transcribed the interviews and analyzed the data using an inductive content analysis approach. The qualitative analyses revealed that ACO clinics are promoting CRC screening through teamwork with enhanced utilization of electronic health records and various other reminder strategies for both providers and patients. Areas for improvement in ACO clinic processes were also identified.

scholarly journals Accountable Care Organizations and Spending for Patients Undergoing Long-Term Dialysis

2020 ◽  
Vol 15 (12) ◽  
pp. 1777-1784
Author(s):  
Shivani Bakre ◽  
John M. Hollingsworth ◽  
Phyllis L. Yan ◽  
Emily J. Lawton ◽  
Richard A. Hirth ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Confidence Interval ◽  
Primary Care Physician ◽  
Accountable Care Organization ◽  
Care Physician ◽  
Accountable Care Organizations ◽  
Care Organization ◽  
Accountable Care

Background and objectivesDespite representing 1% of the population, beneficiaries on long-term dialysis account for over 7% of Medicare’s fee-for-service spending. Because of their focus on care coordination, Accountable Care Organizations may be an effective model to reduce spending inefficiencies for this population. We analyzed Medicare data to examine time trends in long-term dialysis beneficiary alignment to Accountable Care Organizations and differences in spending for those who were Accountable Care Organization aligned versus nonaligned.Design, setting, participants, & measurementsIn this retrospective cohort study, beneficiaries on long-term dialysis between 2009 and 2016 were identified using a 20% random sample of Medicare beneficiaries. Trends in alignment to an Accountable Care Organization were compared with alignment of the general Medicare population from 2012 to 2016. Using an interrupted time series approach, we examined the association between Accountable Care Organization alignment and the primary outcome of total spending for long-term dialysis beneficiaries from prior to Accountable Care Organization implementation (2009–2011) through implementation of the Comprehensive ESRD Care model in October 2015. We fit linear regression models with generalized estimating equations to adjust for patient characteristics.ResultsDuring the study period, 135,152 beneficiaries on long-term dialysis were identified. The percentage of long-term dialysis beneficiaries aligned to an Accountable Care Organization increased from 6% to 23% from 2012 to 2016. In the time series analysis, spending on Accountable Care Organization–aligned beneficiaries was $143 (95% confidence interval, $5 to $282) less per beneficiary-quarter than spending for nonaligned beneficiaries. In analyses stratified by whether beneficiaries received care from a primary care physician, savings by Accountable Care Organization–aligned beneficiaries were limited to those with care by a primary care physician ($235; 95% confidence interval, $73 to $397).ConclusionsThere was a substantial increase in the percentage of long-term dialysis beneficiaries aligned to an Accountable Care Organization from 2012 to 2016. Moreover, in adjusted models, Accountable Care Organization alignment was associated with modest cost savings among long-term dialysis beneficiaries with care by a primary care physician.

scholarly journals The Effects of a Multifaceted Intervention to Improve Care Transitions Within an Accountable Care Organization: Results of a Stepped-Wedge Cluster-Randomized Trial

2020 ◽  
Vol 16 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Jeffrey L Schnipper ◽  
Lipika Samal ◽  
Nyryan Nolido ◽  
Catherine Yoon ◽  
Anuj K Dalal ◽  
...  
Keyword(s):  
Primary Care ◽  
Adverse Events ◽  
Care Transitions ◽  
Hospital Medicine ◽  
Accountable Care Organization ◽  
Care Organization ◽  
Accountable Care ◽  
Stepped Wedge ◽  
Readmission Rates ◽  
Cluster Randomized

BACKGROUND: Transitions from hospital to the ambulatory setting are high risk for patients in terms of adverse events, poor clinical outcomes, and readmission. OBJECTIVES: To develop, implement, and refine a multifaceted care transitions intervention and evaluate its effects on postdischarge adverse events. DESIGN, SETTING, AND PARTICIPANTS: Two-arm, single-blind (blinded outcomes assessor), stepped-wedge, cluster-randomized clinical trial. Participants were 1,679 adult patients who belonged to one of 17 primary care practices and were admitted to a medical or surgical service at either of two participating hospitals within a pioneer accountable care organization (ACO). INTERVENTIONS: Multicomponent intervention in the 30 days following hospitalization, including: inpatient pharmacist-led medication reconciliation, coordination of care between an inpatient “discharge advocate” and a primary care “responsible outpatient clinician,” postdischarge phone calls, and postdischarge primary care visit. MAIN OUTCOMES AND MEASURES: The primary outcome was rate of postdischarge adverse events, as assessed by a 30-day postdischarge phone call and medical record review and adjudicated by two blinded physician reviewers. Secondary outcomes included preventable adverse events, new or worsening symptoms after discharge, and 30-day nonelective hospital readmission. RESULTS: Among patients included in the study, 692 were assigned to usual care and 987 to the intervention. Patients in the intervention arm had a 45% relative reduction in postdischarge adverse events (18 vs 23 events per 100 patients; adjusted incidence rate ratio, 0.55; 95% CI, 0.35-0.84). Significant reductions were also seen in preventable adverse events and in new or worsening symptoms, but there was no difference in readmission rates. CONCLUSION: A multifaceted intervention was associated with a significant reduction in postdischarge adverse events but no difference in 30-day readmission rates. Journal of Hospital Medicine 2020; 15:XXX-XXX. © 2020 Society of Hospital Medicine

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