Examining the Feasibility of Linking National Survey of ACOs to Medicare Claims

描述（由申请人提供）：这项工作的主要目标是检查与责任护理组织（ACO）的绩效相关的组织组成部分。随着医疗保健成本的持续上升，政策制定者和支付者都接受了ACO和其他支付改革模式，作为改善医疗保健和适度成本增长的潜在途径。与传统的按服务收费的支付模式不同，这种模式向提供更多护理的提供者支付更多的费用，而作为负责任护理基础的支付模式向提供者网络支付更多的费用，以实现更低成本的更好护理。来自早期ACO的现有证据显示，支出增长略有放缓，但储蓄变化显著。这表明越来越需要快速而详细的评估，以告知ACO模型的发展，特别是在ACO持续增长的这段时间。《平价医疗法案》于2012年建立了两个自愿医疗保险ACO计划，旨在遏制不断上涨的医疗保健成本并提高医疗质量。虽然ACO模式在公共和私营部门继续增长，但截至2014年1月，医疗保险已成为ACO支付改革的主导者，共有366个医疗保险ACO。到2012年，医疗保险和医疗补助服务中心（CMS）已将近400万或11%的医疗保险受益人分配给ACO，卫生与公众服务部估计，ACO可以在前四年为医疗保险节省高达9.4亿美元。为了实现这一承诺，需要进行研究，研究ACO的特征与成本和质量指标的成功相关。我们建议通过将ACO绩效数据与全国责任医疗组织调查（NSACO）联系起来来解决这一知识差距，该调查包括ACO合同特征，ACO结构和能力以及当地背景等领域的数据。目标1的目的是确定Medicare ACO及其组件提供商的标识符。这将使我们能够使用基于患者护理模式的医疗保险方法将患者归因于这些ACO，并随时间跟踪与ACO相关的医生集。我们的第二个目标是通过将NSACO的数据与医疗保险行政索赔数据联系起来，提高我们对ACO在成本和质量指标上成功表现的贡献者的认识。关联数据将使我们能够将NSACO中ACO报告的组织组件与通过Medicare索赔数据确定的组件进行比较，并比较Medicare ACO计划发布的绩效统计数据，以确定关联的准确性。这项工作将提供一个更好的了解不均匀的成本节约CMS报告中的医疗保险ACO计划的参与者。它对支付模式的演变具有重要意义。

DESCRIPTION (provided by applicant): The broad objective of this work is to examine the organizational components associated with performance of accountable care organizations (ACOs). With the continued rise in health care costs, policymakers and payers alike have embraced ACOs and other payment reform models as a potential way to improve healthcare and moderate cost growth. Unlike traditional fee-for-service payment models, which pay providers more for providing more care, the payment models underlying accountable care pay networks of providers more for achieving better care at lower costs. Existing evidence from early ACOs shows a modest slowing of spending growth, yet significant variation in savings. This suggests a growing need for rapid yet detailed evaluation to inform the development of the ACO model, particularly during this period of sustained ACO growth. The Affordable Care Act established two voluntary Medicare ACO programs in 2012 with the aims of curbing rising health care costs and improving the quality of care. Although the ACO model continues to grow across public and private sectors, Medicare has become the dominant player in ACO payment reform with 366 Medicare ACOs formed as of January 2014. The Centers for Medicare and Medicaid Services (CMS) had assigned nearly 4 million or 11% of Medicare beneficiaries to an ACO by 2012, and Health and Human Services estimates that ACOs could save Medicare up to $940 million in the first four years. To achieve this promise, research is needed that examines which ACO characteristics are associated with success on both cost and quality metrics. We propose to address this knowledge gap by linking ACO performance data to the National Survey of Accountable Care Organizations (NSACO), a survey that includes data on domains such as ACO contract characteristics, ACO structure and capabilities, and local context. The objective of Aim 1 is to determine identifiers for Medicare ACOs and their component providers. This will allow us to attribute patients to these ACOs using Medicare methodology based on patient care patterns and track the set of physicians associated with an ACO over time. Our second aim is to advance our knowledge of the contributors to successful ACO performance on cost and quality metrics by linking data from the NSACO to Medicare administrative claims data. The linked data will allow us to compare ACO-reported organizational components in the NSACO to components as determined through Medicare claims data, and compare performance statistics as published by Medicare ACO programs to determine the accuracy of the linkage. This work will provide a better understanding of uneven cost savings as reported by CMS among Medicare ACO program participants. It has significant implications for the evolution of payment models.