Accountable care organizations and preventable hospitalization among patients with Alzheimer’s disease

Abstract

AbstractBackgroundSystem‐level care coordination strategies can be the most effective to promote continuity of care among people with Alzheimer disease (AD); however, the evidence is lacking. To motivate providers to coordinate the care they provide and shift their focus upstream to prevention, major public and private payers are utilizing novel reimbursement mechanisms, like accountable care organizations (ACOs). The objective of this study is to determine if ACOs are associated with lower rates of potentially preventable hospitalizations for people with AD and if hospital ACO affiliation is associated with reduced racial and ethnic disparities in preventable hospitalizations among patients with AD.MethodThis study employed a cross‐sectional study design and used 2015 Healthcare Cost and Utilization Project inpatient claims data from 11 states and the 2015 American Hospital Association Annual Survey. This study focused on community‐dwelling adults with AD aged ≥65 years. Logistic regression and the Blinder–Oaxaca decomposition method were used.ResultAfrican American patients with AD were less likely to be hospitalized at ACO‐affiliated hospitals than White patients. Among patients with AD that were hospitalized, hospital ACO affiliation was associated with lower odds of potentially preventable hospitalizations (OR=0.86, p=0.02; OR=0.66, p<0.001 with propensity score matching) after controlling for patient characteristics, hospital characteristics, and state indicators. Hospital ACO affiliation explained 3.01% (p<0.01) of the disparity in potentially preventable hospitalizations between White and African American patients but could not explain disparities between White and Latinx patients.ConclusionAs the U.S. population ages, it will become increasingly diverse, as will the population with AD. It is crucial to identify cost‐saving strategies that effectively promote coordination and quality care for this high‐need group, particularly among minorities. This study is the first to provide evidence that ACOs may be effective at preventing PPHs for chronic conditions for people with AD and could reduce racial disparities. Results suggest that future research should explore the impacts of other value‐based payment models on quality of care for people with AD and risk factors as well as the ability of these payment models to reduce disparities.