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

项目总结/摘要 原则上，风险的下放应鼓励大型综合供应商集团实现效率。作为 根据我们之前的研究，Medicare Advantage（MA）中的风险承担计划可能比 传统的医疗保险（TM）在护理质量和资源使用方面，但由于MA计划通常不是 临床上与提供者整合，他们可以对合同提供者施加的影响可能更加有限 责任关怀组织（Accountable Care Organizations，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 医疗保险战略，以控制支出，同时提高医疗质量。ACO取得的收益将 由通过与医疗保险和其他医疗保险合同引入的支付激励措施的变化决定。 支付者及其限制使用和提高护理质量以应对这些激励措施的能力。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以下因素有关： 结构特征，如规模、专业组合和与医院的整合。特别是先进的 初级保健模式，如以病人为中心的医疗之家，已被提出作为基本建设 一批高性能的助理指挥官作为新的薪酬激励措施下业绩的潜在预测因素， 各种因素也可能影响组织参与Medicare ACO计划的决定。 项目3将系统地查明各组织对ACO付款作出有效反应的条件 模型我们专注于参与Medicare ACO计划的组织，因为它们的规模很大， 数量（在我们的分析中，我们预计超过400个ACO），他们的多样性，以及并发症的集中度 商业合同，其中。我们将链接新的国家数据库的供应商组织，他们的 结构能力，以及他们的商业ACO风险承包索赔数据，以确定和描述ACO 和非ACO提供者组。通过阐明项目参与和响应的预测因素， 组织，我们的项目将提供实证基础，促进组织学习从高 执行者，改善ACO合同的结构，并估计计划扩展的潜在收益 现有和新整合的供应商群体。通过评估ACO合同的溢出效应， 马萨诸塞州对ACO的病人不包括在这些合同中，我们的项目也将表征的程度 混合薪酬激励引起的组织变革以及调整激励的潜在好处 跨支付者

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.