Avoiding Unintended Incentives In ACO Payment Models
Avoiding Unintended Incentives In ACO Payment Models
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DOI：
10.1377/hlthaff.2014.0444
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发表时间：
2015-01-01
期刊：
影响因子：
9.7
通讯作者：
McWilliams, J. Michael
中科院分区：
文献类型：
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作者：
Douven, Rudy;McGuire, Thomas G.;McWilliams, J. Michael
责任医疗组织（ACO）的医疗保险共享储蓄计划的一个目标是减少ACO患者的医疗保险支出相对于组织的支出历史。然而，我们发现，目前设定ACO支出目标（或基准）的规则削弱了ACO产生储蓄的激励，甚至可能鼓励更高而不是更低的医疗保险支出。在基准计算中，ACO签订或续签合同前三年的支出权重不相等，新合同开始前一年的权重较高，为0.6。因此，ACO有动机增加当年的支出，以提高未来几年的基准，从而更容易在新的合同期内从医疗保险中获得共享储蓄。我们建议的策略，以提高激励ACO，包括改变用于确定基准和新的支付模式，ACO的支出目标的基础上，不仅对自己的过去的表现，但也对其他ACO或医疗保险提供者的表现的权重。
One goal of the Medicare Shared Savings Program for accountable care organizations (ACOs) is to reduce Medicare spending for ACOs' patients relative to the organizations' spending history. However, we found that current rules for setting ACO spending targets (or benchmarks) diminish ACOs' incentives to generate savings and may even encourage higher instead of lower Medicare spending. Spending in the three years before ACOs enter or renew a contract is weighted unequally in the benchmark calculation, with a high weight of 0.6 given to the year just before a new contract starts. Thus, ACOs have incentives to increase spending in that year to inflate their benchmark for future years and thereby make it easier to obtain shared savings from Medicare in the new contract period. We suggest strategies to improve incentives for ACOs, including changes to the weights used to determine benchmarks and new payment models that base an ACO's spending target not only on its own past performance but also on the performance of other ACOs or Medicare providers.