Abstract
BackgroundAlthough Accountable Care Organizations (ACOs) are defined by the provision of primary care services, the relationship between the intensity of primary care and population-level utilization and costs of health care services has not been examined during early implementation of Medicare Shared Savings Program (MSSP) ACOs. Our objective was to evaluate the association between primary care focus and healthcare utilization and spending in the first performance period of the Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs).MethodsIn this retrospective cohort study, we divided the 220 MSSP ACOs into quartiles of primary care focus based on the percentage of all ambulatory evaluation and management services delivered by a PCP (internist, family physician, or geriatrician).Using multivariable regression, we evaluated rates of utilization and spending during the initial performance period, adjusting for the percentage of non-white patients, region, number of months enrolled in the MSSP, number of beneficiary person years, percentage of dual eligible beneficiaries and percentage of beneficiaries over the age of 74.ResultsThe proportion of ambulatory evaluation and management services delivered by a PCP ranged from <38% (lowest quartile, ACOs with least PCP focus) to >46% (highest quartile, ACOs with greatest PCP focus). ACOs in the highest quartile of PCP focus had higher adjusted rates of utilization of acute care hospital admissions (328 per 1000 person years vs 292 per 1000 person years, p = 0.01) and emergency department visits (756 vs 680 per 1000 person years, p = 0.02) compared with ACOs in the lowest quartile of PCP focus. ACOs in the highest quartile of PCP focus achieved no greater savings per beneficiary relative to their spending benchmarks ($142 above benchmark vs $87 below benchmark, p = 0.13).ConclusionsPrimary care focus was not associated with increased savings or lower utilization of healthcare during the initial implementation of MSSP ACOs.
Highlights
Accountable Care Organizations (ACOs) are defined by the provision of primary care services, the relationship between the intensity of primary care and population-level utilization and costs of health care services has not been examined during early implementation of Medicare Shared Savings Program (MSSP) Affordable Care Act (ACO)
While some believe that the optimal ACO model involves provision of ambulatory care mainly by Primary care physician (PCP), [4,5,6] the relationship between primary care focus and utilization and costs of health care services has not been examined during early implementation of MSSP ACOs
We identified 220 ACOs that joined the MSSP from April 2012 through January 2013
Summary
Accountable Care Organizations (ACOs) are defined by the provision of primary care services, the relationship between the intensity of primary care and population-level utilization and costs of health care services has not been examined during early implementation of Medicare Shared Savings Program (MSSP) ACOs. A primary requirement for participation in the MSSP is that an ACO provides primary care services for at least 5000 Medicare beneficiaries. These new organizations differ widely with respect to both physician composition and the distribution of care provided by primary care physicians (PCPs) and specialist. Herrel et al BMC Health Services Research (2017) 17:139 physicians It is unknown, whether such differences influence ACO performance. While some believe that the optimal ACO model involves provision of ambulatory care mainly by PCPs, [4,5,6] the relationship between primary care focus and utilization and costs of health care services has not been examined during early implementation of MSSP ACOs
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