Project 3: Effects of ACOs in Medicare on Utilization and Quality: Heterogeneity

项目摘要/摘要 原则上，委派风险应鼓励大型综合提供商集团实现效率。AS 根据我们之前的工作，Medicare Advantage(MA)中的风险承担计划可能会产生比 传统的Medicare(TM)在护理质量和资源使用方面，但因为MA计划通常不是 临床上与提供商结合，他们对签约提供商的影响可能更加有限 相对于责任关怀组织(ACOS)。在项目3中，我们将对ACO进行严格的评估 TM中的举措，以确定与综合提供商集团的直接风险合同是否是可行的补充 医疗保险在控制支出的同时提高医疗质量的战略。ACO取得的收益将 由其通过与Medicare和其他公司签订的合同引入的支付激励措施的变化确定 支付者及其限制使用和提高护理质量的能力，以回应这些激励措施。AS 以前的研究表明，ACOs提供更具成本效益的护理的能力可能与 结构特征，如规模、专科组合和与医院的整合。尤其是，高级 以病人为中心的医疗院等初级保健模式已被提议作为必要的建筑 高性能的ACO块。作为新支付激励下业绩的潜在预测指标，这些 因素也可能影响组织参与Medicare ACO计划的决定。 项目3将系统地确定与组织对ACO付款的有效反应有关的条件 模特们。我们专注于参与Medicare ACO计划的组织，因为他们的规模很大 数量(我们在分析中预计超过400个ACO)、它们的多样性以及并发的集中度 其中包括商业ACO合同。我们将链接关于提供者组织、其 结构能力及其商业ACO风险签约到索赔数据以识别和描述ACO 和非ACO提供商组。通过以下方式阐明计划参与和响应的预测因素 组织，我们的项目将为促进组织从高级学习提供经验基础 执行者，改进ACO合同的结构，并估计计划扩展的潜在收益 现有的和新集成的提供程序组。通过评估ACO合同的溢出效应 马萨诸塞州没有包括在这些合同中的ACOS患者，我们的项目也将表征程度 混合支付激励引发的组织变革以及统一激励的潜在好处 在付款人之间。

PROJECT SUMMARY/ABSTRACT In principle, delegating risk should encourage large integrated provider groups to achieve efficiencies. As suggested by our prior work, risk-bearing plans in Medicare Advantage (MA) may produce greater value than Traditional Medicare (TM) in terms of quality of care and resource use, but because MA plans are typically not clinically integrated with providers, the influence they can exert on contracting providers may be more limited relative to Accountable Care Organizations (ACOs). In Project 3, we will conduct rigorous evaluations of ACO initiatives in TM to determine if direct risk contracting with integrated provider groups is a viable complementary strategy for Medicare to control spending while improving quality of care. The gains achieved by an ACO will be determined by the changes in payment incentives introduced through its contracts with Medicare and other payers and its capacity to limit utilization and improve quality of care in response to those incentives. As suggested by previous research, the ability of ACOs to deliver more cost-effective care may be related to structural characteristics such as size, specialty mix, and integration with hospitals. In particular, advanced models of primary care such as the patient-centered medical home have been proposed as essential building blocks of high-performing ACOs. As potential predictors of performance under new payment incentives, these factors may also influence organizations' decisions to participate in the Medicare ACO programs. Project 3 will identify conditions systematically related to effective responses by organizations to ACO payment models. We focus on organizations participating in the Medicare ACO programs because of their large number (we anticipate over 400 ACOs in our analysis), their diversity, and the concentration of concurrent commercial ACO contracts among them. We will link novel national databases on provider organizations, their structural capabilities, and their commercial ACO risk contracting to claims data to identify and describe ACOs and non-ACO provider groups. By elucidating predictors of program participation and responses by organizations, our project will provide an empirical basis for fostering organizational learning from high performers, improving the structure of ACO contracts, and estimating potential gains from program expansion to existing and newly integrated provider groups. By assessing spillover effects of ACO contracts in Massachusetts on ACOs' patients not included in those contracts, our project will also characterize the extent of organizational change elicited by mixed payment incentives and the potential benefits of aligning incentives across payers.