J Michael McWilliams1, Laura A Hatfield1, Michael E Chernew1, Bruce E Landon1, Aaron L Schwartz1. 1. From the Department of Health Care Policy, Harvard Medical School (J.M.M., L.A.H., M.E.C., B.E.L., A.L.S.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (J.M.M.), and the Division of General Internal Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center (B.E.L.) - all in Boston.
Abstract
BACKGROUND: In the Medicare Shared Savings Program (MSSP), accountable care organizations (ACOs) have financial incentives to lower spending and improve quality. We used quasi-experimental methods to assess the early performance of MSSP ACOs. METHODS: Using Medicare claims from 2009 through 2013 and a difference-in-differences design, we compared changes in spending and in performance on quality measures from before the start of ACO contracts to after the start of the contracts between beneficiaries served by the 220 ACOs entering the MSSP in mid-2012 (2012 ACO cohort) or January 2013 (2013 ACO cohort) and those served by non-ACO providers (control group), with adjustment for geographic area and beneficiary characteristics. We analyzed the 2012 and 2013 ACO cohorts separately because entry time could reflect the capacity of an ACO to achieve savings. We compared ACO savings according to organizational structure, baseline spending, and concurrent ACO contracting with commercial insurers. RESULTS: Adjusted Medicare spending and spending trends were similar in the ACO cohorts and the control group during the precontract period. In 2013, the differential change (i.e., the between-group difference in the change from the precontract period) in total adjusted annual spending was -$144 per beneficiary in the 2012 ACO cohort as compared with the control group (P=0.02), consistent with a 1.4% savings, but only -$3 per beneficiary in the 2013 ACO cohort as compared with the control group (P=0.96). Estimated savings were consistently greater in independent primary care groups than in hospital-integrated groups among 2012 and 2013 MSSP entrants (P=0.005 for interaction). MSSP contracts were associated with improved performance on some quality measures and unchanged performance on others. CONCLUSIONS: The first full year of MSSP contracts was associated with early reductions in Medicare spending among 2012 entrants but not among 2013 entrants. Savings were greater in independent primary care groups than in hospital-integrated groups.
BACKGROUND: In the Medicare Shared Savings Program (MSSP), accountable care organizations (ACOs) have financial incentives to lower spending and improve quality. We used quasi-experimental methods to assess the early performance of MSSP ACOs. METHODS: Using Medicare claims from 2009 through 2013 and a difference-in-differences design, we compared changes in spending and in performance on quality measures from before the start of ACO contracts to after the start of the contracts between beneficiaries served by the 220 ACOs entering the MSSP in mid-2012 (2012 ACO cohort) or January 2013 (2013 ACO cohort) and those served by non-ACO providers (control group), with adjustment for geographic area and beneficiary characteristics. We analyzed the 2012 and 2013 ACO cohorts separately because entry time could reflect the capacity of an ACO to achieve savings. We compared ACO savings according to organizational structure, baseline spending, and concurrent ACO contracting with commercial insurers. RESULTS: Adjusted Medicare spending and spending trends were similar in the ACO cohorts and the control group during the precontract period. In 2013, the differential change (i.e., the between-group difference in the change from the precontract period) in total adjusted annual spending was -$144 per beneficiary in the 2012 ACO cohort as compared with the control group (P=0.02), consistent with a 1.4% savings, but only -$3 per beneficiary in the 2013 ACO cohort as compared with the control group (P=0.96). Estimated savings were consistently greater in independent primary care groups than in hospital-integrated groups among 2012 and 2013 MSSP entrants (P=0.005 for interaction). MSSP contracts were associated with improved performance on some quality measures and unchanged performance on others. CONCLUSIONS: The first full year of MSSP contracts was associated with early reductions in Medicare spending among 2012 entrants but not among 2013 entrants. Savings were greater in independent primary care groups than in hospital-integrated groups.
Authors: David I Auerbach; Hangsheng Liu; Peter S Hussey; Christopher Lau; Ateev Mehrotra Journal: Health Aff (Millwood) Date: 2013-10 Impact factor: 6.301
Authors: Hannah T Neprash; Michael E Chernew; Andrew L Hicks; Teresa Gibson; J Michael McWilliams Journal: JAMA Intern Med Date: 2015-12 Impact factor: 21.873
Authors: Gregory C Pope; John Kautter; Randall P Ellis; Arlene S Ash; John Z Ayanian; Lisa I Lezzoni; Melvin J Ingber; Jesse M Levy; John Robst Journal: Health Care Financ Rev Date: 2004
Authors: Ishani Ganguli; Claire Lupo; Alexander J Mainor; Endel John Orav; Bonnie B Blanchfield; Valerie A Lewis; Carrie H Colla Journal: Health Serv Res Date: 2020-07-27 Impact factor: 3.402
Authors: K John McConnell; Stephanie Renfro; Richard C Lindrooth; Deborah J Cohen; Neal T Wallace; Michael E Chernew Journal: Health Aff (Millwood) Date: 2017-03-01 Impact factor: 6.301
Authors: Tudor Borza; Mary K Oerline; Ted A Skolarus; Edward C Norton; Justin B Dimick; Bruce L Jacobs; Lindsey A Herrel; Chad Ellimoottil; John M Hollingsworth; Andrew M Ryan; David C Miller; Vahakn B Shahinian; Brent K Hollenbeck Journal: Ann Surg Date: 2019-05 Impact factor: 12.969
Authors: Lauren G Gilstrap; Haiden A Huskamp; David G Stevenson; Michael E Chernew; David C Grabowski; J Michael McWilliams Journal: Health Aff (Millwood) Date: 2018-10 Impact factor: 6.301
Authors: Shashank S Sinha; Nicholas M Moloci; Andrew M Ryan; Adam A Markovitz; Carrie H Colla; Valerie A Lewis; Brent K Hollenbeck; Brahmajee K Nallamothu; John M Hollingsworth Journal: Circ Cardiovasc Qual Outcomes Date: 2018-08
Authors: John M Hollingsworth; Brahmajee K Nallamothu; Phyllis Yan; Sarah Ward; Sunny Lin; Carrie H Colla; Valerie A Lewis; John Z Ayanian; Brent K Hollenbeck; Andrew M Ryan Journal: Circ Cardiovasc Qual Outcomes Date: 2018-06
Authors: Emeline M Aviki; Stephen M Schleicher; Samyukta Mullangi; Konstantina Matsoukas; Deborah Korenstein Journal: Cancer Date: 2018-04-06 Impact factor: 6.860