Five-year Impact of a Commercial Accountable Care Organization on Health Care Spending, Utilization, and Quality of Care
Five-year Impact of a Commercial Accountable Care Organization on Health Care Spending, Utilization, and Quality of Care
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DOI：
10.1097/mlr.0000000000001179
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发表时间：
2019-11-01
期刊：
影响因子：
3
通讯作者：
Taylor, Erik
中科院分区：
文献类型：
--
作者：
Zhang, Hui;Cowling, David W.;Taylor, Erik
背景：2010年《平价医疗法案》通过后，责任医疗组织(ACO)激增。有连续参与者的纵向ACO研究很少，而且大多数是短期的。目的：这项研究的目的是评估商业ACO对持续登记成员的医疗支出、利用率和质量结果的长期影响。研究设计：采用回溯性队列研究设计和倾向加权差异差异法检查2010-2014年商业ACO实施期间2个ACO队列相对于1个非ACO队列的绩效变化。研究对象：从2008年到2014年，共有40483名商业健康维护组织的成员连续注册。措施：门诊和住院环境中各种服务的成本、使用和质量指标。结果：ACO队列有：(1)ACO手术前2年住院和门诊总费用增加，但后3年变化不明显；(2)后2年通过减少初级保健就诊次数，减少专科、检查和成像费用，减少门诊费用；(3)住院费用、利用率和质量措施在5年中的大部分时间没有差别变化；(4)在预防和糖尿病护理领域，至少有1年的几项质量措施取得了良好效果。结论：商业ACO适度改善了门诊流程质量指标，并在第四年减缓了门诊费用的增长，但对住院费用、使用和质量指标的影响微乎其微。
Background: Accountable Care Organizations (ACOs) have proliferated after the passage of the Affordable Care Act in 2010. Few longitudinal ACO studies with continuous enrollees exist and most are short term. Objective: The objective of this study was to evaluate the long-term impact of a commercial ACO on health care spending, utilization, and quality outcomes among continuously enrolled members. Research Design: Retrospective cohort study design and propensity-weighted difference-in-differences approach were applied to examine performance changes in 2 ACO cohorts relative to 1 non-ACO cohort during the commercial ACO implementation in 2010-2014. Subjects: A total of 40,483 continuously enrolled members of a commercial health maintenance organization from 2008 to 2014. Measures: Cost, use, and quality metrics for various type of services in outpatient and inpatient settings. Results: The ACO cohorts had (1) increased inpatient and outpatient total spending in the first 2 years of ACO operation, but insignificant differential changes for the latter 3 years; (2) decreased outpatient spending in the latter 2 years through reduced primary care visits and lowered spending on specialists, testing, and imaging; (3) no differential changes in inpatient hospital spending, utilization, and quality measures for most of the 5 years; (4) favorable results for several quality measures in preventive and diabetes care domains in at least one of the 5 years. Conclusions: The commercial ACO improved outpatient process quality measures modestly and slowed outpatient spending growth by the fourth year of operation, but had a negligible impact on inpatient hospital cost, use, and quality measures.