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Health Aff (Millwood). 2017 May 1;36(5):876-884. doi: 10.1377/hlthaff.2016.0922.

Bending The Spending Curve By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO.

Author information

1
John Hsu (john.hsu@mgh.harvard.edu) is director of the Clinical Economics and Policy Analysis Program at the Mongan Institute for Health Policy, Massachusetts General Hospital (MGH), which is part of the Partners HealthCare system, and an associate professor in the Department of Medicine and the Department of Health Care Policy at Harvard Medical School, all in Boston, Massachusetts.
2
Mary Price is a senior consulting data analyst at the Mongan Institute, MGH.
3
Christine Vogeli is an assistant professor of medicine at MGH and Harvard Medical School and director of evaluation and research at Partners HealthCare's Center for Population Health.
4
Richard Brand is a professor emeritus in the Department of Epidemiology and Biostatistics at the University of California, San Francisco.
5
Michael E. Chernew is a professor in the Department of Health Care Policy at Harvard Medical School.
6
Sreekanth K. Chaguturu is vice president for population health at Partners HealthCare, a staff physician at MGH, and an instructor in medicine at Harvard Medical School.
7
Eric Weil is senior medical director for population health, Partners HealthCare; associate medical director of the Massachusetts General Physicians Organization; and associate chief of clinical affairs, Division of General Internal Medicine, MGH.
8
Timothy G. Ferris is senior vice president for population health at Partners HealthCare and MGH and an associate professor of medicine at MGH and Harvard Medical School.

Abstract

Accountable care organizations (ACOs) appear to lower medical spending, but there is little information on how they do so. We examined the impact of patient participation in a Pioneer ACO and its care management program on rates of emergency department (ED) visits and hospitalizations and on Medicare spending. We used data for the period 2009-14, exploiting naturally staggered program entry to create concurrent controls to help isolate the program effects. The care management program (the ACO's primary intervention) targeted beneficiaries with elevated but modifiable risks for future spending. ACO participation had a modest effect on spending, in line with previous estimates. Participation in the care management program was associated with substantial reductions in rates for hospitalizations and both all and nonemergency ED visits, as well as Medicare spending, when compared to preparticipation levels and to rates and spending for a concurrent sample of beneficiaries who were eligible for but had not yet started the program. Rates of ED visits and hospitalizations were reduced by 6 percent and 8 percent, respectively, and Medicare spending was reduced by 6 percent. Targeting beneficiaries with modifiable high risks and shifting care away from the ED represent viable mechanisms for altering spending within ACOs.

KEYWORDS:

Accountable Care Organizations; Medicare care management programs; medical spending

PMID:
28461355
DOI:
10.1377/hlthaff.2016.0922
[Indexed for MEDLINE]

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