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

项目 3：医疗保险中 ACO 对利用和质量的影响：异质性

• 批准号: 9110084
• 负责人: John Michael McWilliams
• 金额: $ 28.87万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9110084
• 关键词: Accountability; Affect; Caring; Case Management; Characteristics; Clinical; Contracts; Data; Databases; Enrollment; Evaluation; Face; Fee-for-Service Plans; Fostering; Growth; Heterogeneity; Home environment; Hospitals; Incentives; Insurance Carriers; Learning; Link; Marketing; Massachusetts; Medical; Medicare; Modeling; Organizational Change; Outcome; Participant; Patients; Performance; Price; Primary Health Care; Process; Provider; Quality of Care; Research; Resources; Risk; Savings; Structure; System; Work; base; beneficiary; cost; cost effective; experience; improved; medical specialties; novel; patient oriented; payment; pressure; programs; response; risk sharing; success

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.

项目概要/摘要 原则上，风险下放应鼓励大型综合提供商集团提高效率。作为 根据我们之前的工作表明，Medicare Advantage (MA) 中的风险承担计划可能会产生比 传统医疗保险 (TM) 在护理质量和资源使用方面具有优势，但由于 MA 计划通常不 在与提供者进行临床整合时，他们对签约提供者施加的影响可能更加有限 相对于责任医疗组织 (ACO)。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直接签订风险合同是否是可行的补充 医疗保险控制支出同时提高护理质量的策略。 ACO 所取得的成果将 由通过与医疗保险和其他机构的合同引入的支付激励措施的变化来确定 支付者及其为响应这些激励措施而限制使用和提高护理质量的能力。作为 先前的研究表明，ACO 提供更具成本效益的护理的能力可能与 结构特征，例如规模、专业组合以及与医院的整合。特别是先进的 初级保健模式，例如以患者为中心的医疗之家，已被提议作为必要的建筑 高性能 ACO 块。作为新薪酬激励下绩效的潜在预测因素，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有效应对 ACO 付款相关的条件 模型。我们重点关注参与 Medicare ACO 计划的组织，因为它们规模庞大 数量（我们的分析中预计有超过 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。我们将链接有关提供者组织、其 结构能力及其商业 ACO 风险承包到索赔数据以识别和描述 ACO 和非 ACO 提供者群体。通过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水平学习提供实证基础 执行者，改进 ACO 合同的结构，并估计项目扩展的潜在收益 现有和新整合的提供商群体。通过评估 ACO 合同的溢出效应 马萨诸塞州关于未包含在这些合同中的 ACO 患者，我们的项目还将描述其程度 混合薪酬激励措施引发的组织变革以及调整激励措施的潜在好处 跨付款人。