Miranda B Lam1, Jose F Figueroa1, Jie Zheng1, E John Orav1, Ashish K Jha1. 1. Miranda B. Lam, Jose F. Figueroa, Jie Zheng, E. John Orav, and Ashish K. Jha, Harvard T.H. Chan School of Public Health; Miranda B. Lam, Brigham and Women's Hospital/Dana-Farber Cancer Institute; Jose F. Figueroa and Ashish K. Jha, Brigham and Women's Hospital; and Miranda B. Lam, Jose F. Figueroa, E. John Orav, and Ashish K. Jha, Harvard Medical School, Boston, MA.
Abstract
PURPOSE: Spending on patients with cancer can be substantial and has continued to increase in recent years. Accountable Care Organizations (ACOs) are arguably the most important national experiment to control health care spending, yet how ACOs are managing patients with cancer diagnoses is largely unknown. We aimed to determine whether practices that became ACOs had changes in overall or cancer-specific spending among patients with cancer. METHODS: Using 2011 to 2015 national Medicare claims, practices that became part of ACOs were identified and matched to non-ACO practices within the same geographic region. We calculated total and category-specific annual spending per beneficiary as well as spending for and utilization of emergency departments, inpatient admissions, hospice, chemotherapy, and radiation therapy. A difference-in-differences model was used to examine changes in spending and utilization associated with ACO contracts in the Medicare Shared Savings Program for beneficiaries with cancer. RESULTS: We found that the introduction of ACOs had no meaningful impact on overall spending in patients with cancer (-$308 per beneficiary in ACOs v -$319 in non-ACOs; difference, $11; 95% CI, -$275 to $297; P = .94). We found no changes in total spending in patients within any of the 11 different cancer types examined. Finally, changes in spending and utilization did not meaningfully differ between ACO and non-ACO patients within various categories, including cancer-specific categories. CONCLUSION: Compared with patients with cancer treated at non-ACO practices, being a patient with a cancer diagnosis in a Medicare ACO is not associated with significantly reduced spending or heath care utilization. The introduction of ACOs does not seem to have had any meaningful effect on spending or utilization for patients with a cancer diagnosis.
PURPOSE: Spending on patients with cancer can be substantial and has continued to increase in recent years. Accountable Care Organizations (ACOs) are arguably the most important national experiment to control health care spending, yet how ACOs are managing patients with cancer diagnoses is largely unknown. We aimed to determine whether practices that became ACOs had changes in overall or cancer-specific spending among patients with cancer. METHODS: Using 2011 to 2015 national Medicare claims, practices that became part of ACOs were identified and matched to non-ACO practices within the same geographic region. We calculated total and category-specific annual spending per beneficiary as well as spending for and utilization of emergency departments, inpatient admissions, hospice, chemotherapy, and radiation therapy. A difference-in-differences model was used to examine changes in spending and utilization associated with ACO contracts in the Medicare Shared Savings Program for beneficiaries with cancer. RESULTS: We found that the introduction of ACOs had no meaningful impact on overall spending in patients with cancer (-$308 per beneficiary in ACOs v -$319 in non-ACOs; difference, $11; 95% CI, -$275 to $297; P = .94). We found no changes in total spending in patients within any of the 11 different cancer types examined. Finally, changes in spending and utilization did not meaningfully differ between ACO and non-ACO patients within various categories, including cancer-specific categories. CONCLUSION: Compared with patients with cancer treated at non-ACO practices, being a patient with a cancer diagnosis in a Medicare ACO is not associated with significantly reduced spending or heath care utilization. The introduction of ACOs does not seem to have had any meaningful effect on spending or utilization for patients with a cancer diagnosis.
Authors: Nancy L Keating; Shalini Jhatakia; Gabriel A Brooks; Amanda S Tripp; Inna Cintina; Mary Beth Landrum; Qing Zheng; Thomas J Christian; Roberta Glass; Van Doren Hsu; Colleen M Kummet; Susannah Woodman; Carol Simon; Andrea Hassol Journal: JAMA Date: 2021-11-09 Impact factor: 56.272
Authors: Ravi B Parikh; Justin E Bekelman; Qian Huang; Joseph R Martinez; Ezekiel J Emanuel; Amol S Navathe Journal: J Oncol Pract Date: 2019-08-08 Impact factor: 3.714
Authors: Angela B Mariotto; Lindsey Enewold; Jingxuan Zhao; Christopher A Zeruto; K Robin Yabroff Journal: Cancer Epidemiol Biomarkers Prev Date: 2020-06-10 Impact factor: 4.090