Will the Reach of ACOs Extend to Specialty Care?

ACO 的覆盖范围是否会扩展到特殊护理？

• 批准号: 9916669
• 负责人: John Malcolm Hollingsworth
• 金额: $ 32.15万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9916669
• 关键词: Will; Reach; ACOs; Extend; Specialty

PROJECT SUMMARY The Patient Protection and Affordable Care Act of 2010 included a variety of payment and delivery system reforms to curb health spending, the most notable of which was the establishment of Medicare accountable care organizations (ACOs). Much of the initial focus of ACOs has been on enhanced primary care for beneficiaries who have multiple chronic conditions; however, there are reasons to believe that ACOs may benefit other key healthcare sectors where room for improvement exists. Specialty care is one such sector with major implications for ACOs' shared savings goals, given wide variation in its utilization and expenditures that account for nearly 50% of all health spending. While ACOs do not explicitly target specialty care, their emphasis on deeper clinical integration and greater financial stewardship could fundamentally change specialist referral patterns among primary care physicians (PCPs) and have an impact on specialists' treatment decisions when the care is of questionable value. Yet ACOs' impact on specialty care could also be limited. Most Medicare ACO contracts do not encompass specialist practices. Insofar as these providers remain weakly connected to PCPs accepting shared accountability, ACOs may have little influence on specialty care utilization and cost efficiency. They may even create perverse incentives that worsen outcomes. In this context, we propose a study to assess the impact that ACOs have on specialty care delivery. Our proposal has the following three Specific Aims. Aim 1: To measure the effects of ACOs on PCP-specialist referral networks. Using national Medicare data, we will identify patients with one of four tracer conditions (ischemic heart disease, lower extremity joint pain, and newly diagnosed breast or prostate cancer) and the provider groups that care for them. We will distinguish between groups participating in a Medicare ACO and those that are not. We will then use network analytical tools to measure specialist referral patterns in these groups before and after ACO formation. Aim 2: To assess the effects of ACOs on specialists' treatment decisions. Next, we will calculate utilization rates of high- and low-value diagnostic and therapeutic care processes across the patient cohorts identified in Aim 1. We will compare these rates among participating and non-participating provider groups before and after ACO formation. Aim 3: To determine the effects of ACOs on the efficiency of the treatment episode. Finally, we will determine Medicare payments made during treatment episodes before and after ACO formation. We will explore potential sources of savings, including component payments for physician services and hospital and ED care. Findings from our study will be directly relevant to the Agency for Healthcare Research & Quality's Research Priority Area #3, as they will inform policymakers at Medicare about the effects of ACOs on specialty care delivery.

项目摘要 2010年的《患者保护和负担得起的护理法》包括各种付款和交付系统 改革以遏制健康支出，其中最著名的是建立Medicare责任 护理组织（ACO）。 ACO的大部分重点都集中在增强的初级保健上 具有多种慢性病的受益人；但是，有理由相信Acos可能 受益于其他关键医疗领域，那里存在改进空间。专业护理就是这样的领域 鉴于其利用率和支出的广泛差异，对ACO的共享储蓄目标的主要影响 占所有健康支出的近50％。虽然ACO并未明确针对专业护理 强调更深层次的临床整合和更大的财务管理可以从根本上改变 初级保健医生（PCP）的专家推荐模式，并对专家的治疗产生影响 当护理具有可疑价值时的决定。然而，ACO对专业护理的影响也可能受到限制。 大多数Medicare ACO合同不包括专家实践。就这些提供者仍然存在 与接受共同责任制的PCP相连的弱连接，ACO可能对专业护理影响不大 利用和成本效率。他们甚至可能会产生不利的激励措施，从而恶化结果。在这种情况下， 我们提出了一项研究，以评估ACO对专业护理提供的影响。我们的建议有 遵循三个具体目标。目的1：测量ACO对PCP特殊主义推荐的影响 网络。使用国家医疗保险数据，我们将确定患有四个示踪剂条件之一的患者（缺血性 心脏病，下肢关节疼痛以及新诊断的乳腺癌或前列腺癌）和提供者 关心他们的小组。我们将区分参加Medicare ACO的小组和那些 不是。然后，我们将使用网络分析工具来测量这些组之前的专家推荐模式 并在ACO形成之后。目标2：评估ACO对专家治疗决策的影响。下一个， 我们将计算跨整个高价值和低价值诊断和治疗护理过程的利用率 在AIM 1中确定的患者队列。我们将在参与和非参与中比较这些速率 ACO成立前后的提供者组。目标3：确定ACO对效率的影响 治疗情节。最后，我们将确定治疗情节中进行的医疗保险付款 ACO形成之前和之后。我们将探索潜在的储蓄来源，包括零件支付 用于医师服务和医院和ED护理。我们研究的发现将与该机构直接相关 对于医疗保健研究与质量的研究优先领域，他们将通知Medicare的决策者 关于ACO对专业护理提供的影响。