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Golla V, Allen Lapointe NM, Silberberg M, Wang V, Lentz TA, Kaye DR, Sorenson C, Saunders R, Kaufman BG. Improving health equity for older people with serious illness through value based payment reform. J Am Geriatr Soc 2022; 70:2180-2185. [PMID: 35474173 DOI: 10.1111/jgs.17815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Vishnukamal Golla
- National Clinician Scholars Program, Duke University, Durham, North Carolina, USA.,Department of Surgery, Division of Urology, Duke University School of Medicine, Durham, North Carolina, USA.,Health Services Research and Development, Durham VA Healthcare System, Durham, North Carolina, USA
| | - Nancy M Allen Lapointe
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mina Silberberg
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Virginia Wang
- Health Services Research and Development, Durham VA Healthcare System, Durham, North Carolina, USA.,Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Trevor A Lentz
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Deborah R Kaye
- Department of Surgery, Division of Urology, Duke University School of Medicine, Durham, North Carolina, USA.,Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA.,Duke Cancer Institute, Durham, North Carolina, USA
| | - Corinna Sorenson
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA.,Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Robert Saunders
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
| | - Brystana G Kaufman
- Health Services Research and Development, Durham VA Healthcare System, Durham, North Carolina, USA.,Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Simon B, Amelung VE. [10 Years Accountable Care Organizations in the USA: Impulses for Health Care Reform in Germany?]. DAS GESUNDHEITSWESEN 2022; 84:e12-e24. [PMID: 35114697 DOI: 10.1055/a-1718-3332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
GOAL OF THE STUDY An intent of the Patient Protection and Affordable Care Acts (ACA), also know as Obama Care, was to slow the expenditure growth in the public Medicare-System by shifting the accountability for health care outcomes and costs to the provider. For this purpose, provider were allowed to form networks, which would then take accountability for a defined population - Accountable Care Organizations (ACOs). Ten years after the introduction of ACOs, this paper looks at the impact of ACOs both on quality of care and costs of care to assess if ACOs can be a model of care delivery for Germany. METHODS In a mixed-method approach, a rapid review was conducted in Health System Evidence and PubMed. This was supported with further papers identified using the snowballing-technique. After screening the abstracts, we included articles containing information on cost- and/or quality impact of US-Medicare-ACOs. The findings of the rapid review were challenged with 16 ACO-experts and stakeholder in the USA. RESULTS In total, we included 60 publications which incorporated 6 reports that were either conducted directly by governmental institutions or ordered by them, along with 3 previous reviews. Among these, 31 contained information on costs of care, 18 contained information on quality of care and 11 had information on both aspects. The publications show that ACOs reduced costs of of care. Cost reductions were achieved compared to historic costs, to populations not cared for in ACOs, and counterfactuals. Quality of care stayed the same or improved. CONCLUSION ACOs contributed to slowing the cost growth in US Medicare without compromising quality of care. Thus, a transferal of this model of care to Germany should be considered. However, various policies have led to ACOs failing to unleash their full potential. Against this background, and against the background of stark differences between US Medicare and the German health care system, a critical reflection of the necessary policies underlying ACOs-like structures in Germany, needs to be undertaken.
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Affiliation(s)
- Benedikt Simon
- Harkness Fellowship, Commonwealth Fund, New York, United States.,Chief Officer Integrated and Digital Care, Asklepios Kliniken GmbH & Co. KGaA, Hamburg, Germany
| | - Volker Eric Amelung
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Germany
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Trombley MJ, McWilliams JM, Fout B, Morefield B. ACO Investment Model Produced Savings, But The Majority Of Participants Exited When Faced With Downside Risk. Health Aff (Millwood) 2022; 41:138-146. [PMID: 34982636 DOI: 10.1377/hlthaff.2020.01819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medicare's Accountable Care Organization (ACO) Investment Model (AIM) provided up-front funding to forty-one small, rurally located ACOs to encourage their participation in the Medicare Shared Savings Program. We estimate net savings to Medicare of $381.5 million over three years, driven by utilization reductions in inpatient and other institutional care and by the absence of shared risk for potential increases in Medicare spending incurred by participants. These savings suggest that population-based payment models can enable providers to better meet the needs of rural populations through greater flexibility in care delivery. However, nearly two-thirds of AIM ACOs exited the Medicare Shared Savings Program when faced with the requirement to assume downside financial risk, starting in year four of participation. As the Centers for Medicare and Medicaid Services builds on AIM and rural hospital global payment models, our findings suggest that new payment models can support more efficient use of resources to meet the health care needs of rural populations. However, the findings also caution against the vigorous pursuit of savings as a primary goal of payment models in traditionally underserved communities.
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Affiliation(s)
| | - J Michael McWilliams
- J. Michael McWilliams, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Betty Fout
- Betty Fout, Abt Associates Inc., Rockville, Maryland
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Drewry KM, Trivedi AN, Wilk AS. Organizational Characteristics Associated with High Performance in Medicare's Comprehensive End-Stage Renal Disease Care Initiative. Clin J Am Soc Nephrol 2021; 16:1522-1530. [PMID: 34620648 PMCID: PMC8499003 DOI: 10.2215/cjn.04020321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Medicare plans to extend financial structures tested through the Comprehensive End-Stage Renal Disease Care (CEC) Initiative-an alternative payment model for maintenance dialysis providers-to promote high-value care for beneficiaries with kidney failure. The End-Stage Renal Disease Seamless Care Organizations (ESCOs) that formed under the CEC Initiative varied greatly in their ability to generate cost savings and improve patient health outcomes. This study examined whether organizational or community characteristics were associated with ESCOs' performance. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used a retrospective pooled cross-sectional analysis of all 37 ESCOs participating in the CEC Initiative during 2015-2018 (n=87 ESCO-years). Key exposures included ESCO characteristics: number of dialysis facilities, number and types of physicians, and years of CEC Initiative experience. Outcomes of interest included were above versus below median gross financial savings (2.4%) and standardized mortality ratio (0.93). We analyzed unadjusted differences between high- and low-performing ESCOs and then used multivariable logistic regression to construct average marginal effect estimates for parameters of interest. RESULTS Above-median gross savings were obtained by 23 (52%) ESCOs with no program experience, 14 (32%) organizations with 1 year of experience, and seven (16%) organizations with 2 years of experience. The adjusted likelihoods of achieving above-median gross savings were 23 (95% confidence interval, 8 to 37) and 48 (95% confidence interval, 24 to 68) percentage points higher for ESCOs with 1 or 2 years of program experience, respectively (versus none). The adjusted likelihood of achieving above-median gross savings was 1.7 (95% confidence interval, -3 to -1) percentage points lower with each additional affiliated dialysis facility. Adjusted mortality rates were lower for ESCOs located in areas with higher socioeconomic status. CONCLUSIONS Smaller ESCOs, organizations with more experience in the CEC Initiative, and those located in more affluent areas performed better under the CEC Initiative.
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MESH Headings
- Accountable Care Organizations/economics
- Accountable Care Organizations/organization & administration
- Cost Savings
- Cost-Benefit Analysis
- Cross-Sectional Studies
- Delivery of Health Care, Integrated/economics
- Delivery of Health Care, Integrated/organization & administration
- Health Care Costs
- Humans
- Kidney Failure, Chronic/diagnosis
- Kidney Failure, Chronic/economics
- Kidney Failure, Chronic/mortality
- Kidney Failure, Chronic/therapy
- Medicare/economics
- Medicare/organization & administration
- Neighborhood Characteristics
- Outcome and Process Assessment, Health Care/economics
- Outcome and Process Assessment, Health Care/organization & administration
- Quality Assurance, Health Care/organization & administration
- Quality Indicators, Health Care/organization & administration
- Renal Dialysis/adverse effects
- Renal Dialysis/economics
- Renal Dialysis/mortality
- Retrospective Studies
- Social Class
- Time Factors
- Treatment Outcome
- United States
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Affiliation(s)
- Kelsey M. Drewry
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Amal N. Trivedi
- Department of Health Services, Policy and Practice, Department of Medicine, Brown University, Providence, Rhode Island
- Department of Medicine, Brown University, Providence, Rhode Island
| | - Adam S. Wilk
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia
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