Development and Performance of Medicaid ACOs

 描述（由申请人提供）：在全国范围内，许多人都在寻找责任护理组织（ACO），以改善医疗保险和私人保险患者的护理和降低成本。许多州对医疗补助中的ACO都有类似的目标，但医疗补助人口面临的独特情况要求与医疗保险和私人ACO目前使用的方法有很大的不同。2015年初，新泽西将实施一项为期3年的示范，以测试其医疗补助计划中的ACO概念。这项拟议的研究将提供第一个严格的大规模评估医疗补助ACO的结果。它还将严格评估ACO绩效衡量的关键要素，这对于医疗补助和其他支付者进一步制定负责任的护理战略至关重要。第一个项目的目的是测试的假设，在医疗补助ACO的患者经历较低的支出和/或提高质量相对于其他医疗补助登记。根据这一目标，差异中的差异模型将应用于多年的全州医疗补助索赔和管理式护理遭遇记录。在子目标中，基于索赔/遭遇数据的模拟模型将用于评估替代方法的准确性和统计可靠性，以衡量与Medicaid ACO活动相关的节省。在第二个项目目标下，将使用深入的定性访谈来评估ACO如何重新设计护理，与患者互动，并根据积累的经验修改他们的策略。第三个项目的目标是定期与新泽西州和全国各地的医疗补助官员和负责任的护理利益相关者进行接触，以直接告知有关负责任的护理政策和实践的决策。在项目的每个阶段，将通过现有的州和国家合作，向这些小组征求关于评价措施和模拟情景的意见，以最大限度地提高项目结果的实际相关性和迅速传播。传播产品将包括向Medicaid ACO提供的早期数据报告、网络研讨会、面对面简报、政策导向问题简报和同行评审手稿。

 DESCRIPTION (provided by applicant): Across the nation, many are looking to Accountable Care Organizations (ACOs) to improve care and reduce costs for Medicare and privately insured patients. A number of states have similar goals for ACOs in Medicaid, but the unique circumstances facing the Medicaid population require substantial departures from the approaches currently used within Medicare and private ACOs. In early 2015, New Jersey will implement a 3-year demonstration to test the ACO concept within its Medicaid program. The proposed study will provide the first rigorous large- scale evaluation of Medicaid ACO outcomes. It will also rigorously assess key elements of ACOs performance measurement, which are essential for further development of accountable care strategies by Medicaid and other payers. The first project aim is to test the hypothesis that patients in Medicaid ACOs experience lower spending and/or improved quality relative to other Medicaid enrollees. Under this aim, difference-in-differences models will be applied to multiple years of statewide Medicaid claims and managed care encounter records. In a subaim, simulation models based on the claims/encounter data will be used to assess the accuracy and statistical reliability of alternativ methods for measuring savings associated with Medicaid ACO activities. Under the second project aim, in-depth qualitative interviews will be used to assess how ACOs are redesigning care, engaging with patients, and modifying their strategies with accumulated experience. The third project aim is to engage regularly with Medicaid officials and accountable care stakeholders in NJ and across the nation to directly inform decision making about accountable care policy and practice. Input on evaluation measures and simulation scenarios will be solicited from these groups via existing state and national collaborations at every stage of the project to maximize the practical relevance and rapid dissemination of project findings. Dissemination products will include early data reports to Medicaid ACOs, webinars, in- person briefings, policy oriented issue briefs, and peer-reviewed manuscripts.