Accountable to Whom? How Accountable Care Organizations Jeopardize Medicare Beneficiaries’ Health Information and Choice

2012 ◽  
Author(s):  
Evan Lazerowitz
Keyword(s):  
Health Information ◽  
Accountable Care Organizations ◽  
Accountable Care ◽  
Medicare Beneficiaries

Abstract 058: Early Effect of Medicare Accountable Care Organizations on Acute Myocardial Infarction Episode Payments

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Shashank S Sinha ◽  
Nicholas M Moloci ◽  
Andrew M Ryan ◽  
Brahmajee K Nallamothu ◽  
John M Hollingsworth
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Accountable Care Organizations ◽  
Accountable Care ◽  
Medicare Beneficiaries ◽  
Physician Services ◽  
Post Discharge ◽  
Early Effect ◽  
Medicare Data ◽  
The Difference

Objective: Spending for acute myocardial infarction (AMI) episodes varies widely across hospitals, driven primarily by payments made more than 30 days after discharge. Through collective incentives and an emphasis on care coordination, Medicare accountable care organizations (ACOs) may help reduce this variation. To test this hypothesis, we analyzed national Medicare data. Methods: Using a 20% random sample, we identified Medicare beneficiaries admitted for AMI from January 2010 to December 2013. We distinguished admissions to hospitals affiliated with a Medicare ACO from those that were not. We then calculated 90-day, price-standardized, risk-adjusted episode payments made on behalf of beneficiaries, differentiating between early (index admission to 30 days post-discharge) and late payments (31 to 90 days). We also calculated component payments, including those for the index hospitalization, readmissions, physician services, and post-acute care. Finally, we used difference-in-differences estimation to measure the effect of admission to an ACO-affiliated hospital on early and late episode payments. Results: Over the study period, 15,219 beneficiaries were admitted to 299 eventual ACO-affiliated hospitals and 73,910 were admitted to 1,685 never ACO-affiliated hospitals ( p <0.001). While beneficiaries admitted to eventual ACO-affiliated hospitals tended to be younger than those admitted to never ACO-affiliated hospitals (mean age: 79.2 ± 8.6 versus 80.0 ± 8.5, respectively; p =.003), they had similar levels of comorbidity (mean Elixhauser score: 2.7 ± 1.4 versus 2.7 ± 1.4, respectively; p =0.526). Mean 90-day episode payments were greater for ACO-affiliated hospitals [$24,887 versus $23,966; p <0.001]. In the period after ACO implementation (2012 and 2013), total payments for AMI episodes fell by $1259 (Figure; p <0.001). Most of this savings was attributable to decreases in early ($1118) versus late ($141) episode payments. However, none of these savings differed based on admission to an ACO-affiliated hospital ( p =0.363 for the difference). Conclusions: Early Medicare ACOs have not affected 90-day episode payments for AMI admissions. Future studies should explore the possibility of heterogeneity in effect based on ACO structure.

Outcomes and cost among Medicare beneficiaries hospitalized for heart failure assigned to accountable care organizations

2020 ◽  
Vol 226 ◽  
pp. 13-23 ◽  
Author(s):  
Nancy Luo ◽  
Bradley G. Hammill ◽  
Adam D. DeVore ◽  
Haolin Xu ◽  
Gregg C. Fonarow ◽  
...  
Keyword(s):  
Heart Failure ◽  
Accountable Care Organizations ◽  
Accountable Care ◽  
Medicare Beneficiaries

Using health information technology to manage a patient population in accountable care organizations

2016 ◽  
Vol 30 (4) ◽  
pp. 581-596 ◽  
Author(s):  
Frances M Wu ◽  
Thomas G. Rundall ◽  
Stephen M. Shortell ◽  
Joan R Bloom
Keyword(s):  
Information Technology ◽  
Data Integration ◽  
Health Information Technology ◽  
Health Information ◽  
Patient Population ◽  
Care Management ◽  
Accountable Care Organizations ◽  
Accountable Care ◽  
Electronic Health Record Data ◽  
Content Type

Purpose – The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population. Design/methodology/approach – Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013). Findings – Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it. Research limitations/implications – Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses. Practical implications – ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population. Originality/value – Using new empirical data, this study increases understanding of the extent of ACOs’ current and developing HIT capabilities to support ongoing care management.

Performance of Accountable Care Organizations: Health Information Technology and Quality–Efficiency Trade-Offs

2021 ◽  
Author(s):  
Chenzhang Bao ◽  
Indranil R. Bardhan
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Financial Incentives ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Cost Of Care ◽  
Accountable Care Organizations ◽  
Accountable Care ◽  
Trade Offs

Under a traditional fee-for-service payment model, healthcare providers typically compromise the quality of care in order to reduce costs. Drawing on data from a national sample of accountable care organizations (ACOs), we study whether financial incentives offered under the Affordable Care Act led to fundamental changes in care delivery. Our research suggests that effective use of health information technology (IT) by ACO providers is critical in balancing competing goals of quality and efficiency. Unlike hospitals that did not participate in value-based care initiatives, ACOs were able to generate better quality outcomes while also improving overall efficiency. Furthermore, ACO providers that used health IT effectively demonstrated better patient health outcomes due to greater information integration with other providers. In other words, ACOs created value by not only reducing the cost of care but also improving patient outcomes simultaneously. Our research provides a roadmap for practitioners to succeed in a value-based healthcare environment and for policy makers to design better incentives to promote interorganizational information sharing across providers. Our findings suggest that healthcare policy needs to incorporate appropriate incentives to foster effective IT use for care coordination between healthcare providers.

Accountable care organizations and the use of prostate cancer screening and breast cancer screening.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18308-e18308
Author(s):  
Quoc-Dien Trinh ◽  
Christian Meyer ◽  
Anna Krasnova ◽  
Jesse Sammon ◽  
Stuart R. Lipsitz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Propensity Score ◽  
Prostate Cancer Screening ◽  
Accountable Care Organizations ◽  
Accountable Care ◽  
Medicare Beneficiaries ◽  
Shared Savings

e18308 Background: Accountable Care Organizations (ACOs) were established under the Affordable Care Act as a new payment model intended to impose greater responsibility on all stakeholders for cost control and quality improvement. Preventive services are an ideal target to monitor the effectiveness of new health care delivery models. We sought to examine and compare the prevalence of breast cancer screening (BCa-S), and prostate cancer screening (PCa-S) between ACO and traditional Medicare beneficiaries. We hypothesized that the use of BCa-S is higher among beneficiaries attributed to an ACO, whereas the use of PCa-S, a non-recommended test, would be unaffected by ACO assignment. Methods: Using a random 20% sample of Medicare beneficiaries, we assessed BCa-S in women aged < 75, (evidence-based cancer screening), and PCa-S in men < 75 (non-recommended cancer screening) between January 1, 2013 and December 31, 2013 with appropriate exclusion criteria following the review of guideline recommendations. ACO coverage was ascertained from the quarterly assignment in the Shared Savings Program ACO Beneficiary-level file. Propensity-score weighting was performed to balance out patient and sociodemographic covariates. Results: Following propensity-score weighting, our final cohorts of ACO and traditional Medicare beneficiaries included 52,987 and 526,063 women for BCa-S; 86,936 and 814,221 men for PCa-S, respectively. The prevalence of screening in ACO vs. traditional Medicare were 35.0% vs. 25.2% for BCa-S, and 54.6% vs. 41.7% for PCa-S (all p < 0.001) Conclusions: The ACO model appears to have a salutary effect on preventive service utilization. Our findings vis-à-vis PCa-S among ACOs are likely a reflection of improved health care access rather than vetted screening practices. There is hope that such nonrecommended screening will decrease if more ACOs are required to move towards a “two-sided” risk shared savings and loss model.

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