Early Performance of Accountable Care Organizations in Medicare

被引：316

作者：

McWilliams, J. Michael ^{[1
,2
,3
]}

Hatfield, Laura A. ^{[1
]}

Chernew, Michael E. ^{[1
]}

Landon, Bruce E. ^{[1
,4
]}

Schwartz, Aaron L. ^{[1
]}

机构：

[1] Harvard Univ, Sch Med, Dept Hlth Care Policy, 180 Longwood Ave, Boston, MA 02115 USA

[2] Brigham & Womens Hosp, Dept Med, Div Gen Internal Med & Primary Care, 75 Francis St, Boston, MA 02115 USA

[3] Harvard Univ, Sch Med, Boston, MA 02115 USA

[4] Beth Israel Deaconess Med Ctr, Dept Med, Div Gen Internal Med & Primary Care, Boston, MA 02215 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2016年 / 374卷 / 24期

基金：

美国国家卫生研究院;

关键词：

QUALITY-OF-CARE; VERTICAL INTEGRATION; PHYSICIAN PRACTICES; RISK ADJUSTMENT; ACOS; BENEFICIARIES; LEADERSHIP; OWNERSHIP; PATIENT; PAYMENT;

D O I：

10.1056/NEJMsa1600142

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND In the Medicare Shared Savings Program (MSSP), accountable care organizations (ACOs) have financial incentives to lower spending and improve quality. We used quasi-experimental methods to assess the early performance of MSSP ACOs, METHODS Using Medicare claims from 2009 through 2013 and a difference-in-differences design, we compared changes in spending and in performance on quality measures from before the start of AGO contracts to after the start of the contracts between beneficiaries served by the 220 ACOs entering the MSSP in mid-2012 (2012 ACO cohort) or January 2013 (2013 ACO cohort) and those served by non-ACO providers (control group), with adjustment for geographic area and beneficiary characteristics. We analyzed the 2012 and 2013 ACO cohorts separately because entry time could reflect the capacity of an ACO to achieve savings. We compared ACO savings according to organizational structure, baseline spending, and concurrent AGO contracting with commercial insurers. RESULTS Adjusted Medicare spending and spending trends were similar in the ACO cohorts and the control group during the precontract period. In 2013, the differential change (i.e., the between-group difference in the change from the precontract period) in total adjusted annual spending was -$144 per beneficiary in the 2012 ACO cohort as compared with the control group (P=0.02), consistent with a 1.4% savings, but only -$3 per beneficiary in the 2013 ACO cohort as compared with the control group (P=0.96). Estimated savings were consistently greater in independent primary care groups than in hospital-integrated groups among 2012 and 2013 MSSP entrants (P=0.005 for interaction). MSSP contracts were associated with improved performance on some quality measures and unchanged performance on others. CONCLUSIONS The first full year of MSSP contracts was associated with early reductions in Medicare spending among 2012 entrants but not among 2013 entrants. Savings were greater in independent primary care groups than in hospital-integrated groups.

引用

页码：2357 / 2366

页数：10

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