Development and Performance of Medicaid ACOs

 描述(由申请人提供)：在全国各地，许多人都在寻求负责任的护理组织(ACO)来改善医疗保健并降低医疗保险和私人保险患者的成本。许多州对医疗补助中的ACO有类似的目标，但医疗补助人口面临的独特情况要求大幅偏离目前在联邦医疗保险和私人ACO中使用的方法。2015年初，新泽西州将实施为期3年的演示，在其医疗补助计划中测试ACO概念。这项拟议的研究将首次对医疗补助ACO结果进行严格的大规模评估。它还将严格评估ACOS绩效衡量的关键要素，这些要素对于医疗补助和其他付款人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检验这样一个假设，即与其他参加医疗补助的人相比，参加医疗补助ACO的患者经历了更低的支出和/或更高的质量。在这一目标下，差异差异模型将应用于全州范围内多年的医疗补助申请和管理护理遭遇记录。在子目标中，将使用基于索赔/遭遇数据的模拟模型来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如何根据积累的经验重新设计护理、与患者接触并修改他们的策略。第三个项目的目标是与新泽西州和全国各地的医疗补助官员和负责任的医疗利益攸关方定期接触，直接为决策提供关于负责任的医疗政策和实践的信息。将在项目的每个阶段通过现有的国家和国家合作，征求这些小组对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。传播产品将包括向医疗补助ACO提交的早期数据报告、网络研讨会、面对面的简报、以政策为导向的问题简报和同行评议的手稿。

 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.